Sanders Jessica N, Turok David K, Gawron Lori M, Law Amy, Wen Lonnie, Lynen Richard
University of Utah Department of Obstetrics and Gynecology, Salt Lake City, UT.
University of Utah Department of Obstetrics and Gynecology, Salt Lake City, UT.
Am J Obstet Gynecol. 2017 Jun;216(6):590.e1-590.e8. doi: 10.1016/j.ajog.2017.02.003. Epub 2017 Feb 8.
As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined 2-year continuation rates for the levonorgestrel 52-mg intrauterine device, the copper T380A intrauterine device, and the 68-mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement.
The purpose of this study was to examine the proportion and characteristics of women who continue intrauterine device and implant use to 2 years and to relate continuation to device type when controlling for patient characteristics.
This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004, and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence risk ratios and to relate the probability of 2-year continuous use to device type.
Data on 8603 device insertions were obtained with the following distribution: levonorgestrel 52-mg intrauterine devices (6459; 75.1%), copper T380A intrauterine devices (1136; 13.2%), and 68-mg etonogestrel implant (1008; 11.7%). Two-year continuation rates were 77.8%, 73.1%, and 75.9%, respectively. There was no statistical difference in 2-year continuation between levonorgestrel 52-mg intrauterine device users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) and 68-mg etonogestrel implant users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) compared with copper device users, after we controlled for age, Hispanic ethnicity, payer type, and year of insertion. Older-age, self-pay, or public payer insurance (reference commercial payer) and Hispanic ethnicity were associated with 2-year continuation.
Three-quarters of women with an intrauterine device or implant continue using it for 2 years. In this cohort, the 2-year continuation rates were 77.8%, 73.1%, and 75.9% for the levonorgestrel 52-mg intrauterine device, copper T380A intrauterine device, and 68-mg etonogestrel implant, respectively.
随着长效可逆避孕方法的普及，在不同临床环境中获取准确的方法持续使用数据的需求也在增加。我们在一个具有混合支付报销的学术医疗系统中，确定了52毫克左炔诺孕酮宫内节育器、T380A铜宫内节育器和68毫克依托孕烯避孕植入剂的2年持续使用率。
本研究的目的是调查持续使用宫内节育器和植入剂达2年的女性的比例及特征，并在控制患者特征的情况下，将持续使用情况与节育器类型相关联。
这项回顾性图表审查评估了2004年1月1日至2012年12月31日期间在犹他大学医疗系统植入宫内节育器或避孕植入剂的患者。我们通过查询电子数据仓库中的计费、用药和程序数据，确定了使用者以及植入和取出的日期。进行多变量泊松回归以估计发病风险比，并将2年持续使用的概率与节育器类型相关联。
获得了8603例节育器植入的数据，分布如下：52毫克左炔诺孕酮宫内节育器（6459例；75.1%）、T380A铜宫内节育器（1136例；13.2%）和68毫克依托孕烯植入剂（1008例；11.7%）。2年持续使用率分别为77.8%、73.1%和75.9%。在控制了年龄、西班牙裔种族、支付方类型和植入年份后，与铜节育器使用者相比，52毫克左炔诺孕酮宫内节育器使用者（调整风险比，1.1；95%置信区间，1.0 - 1.1）和68毫克依托孕烯植入剂使用者（调整风险比，1.1；95%置信区间，1.0 - 1.1）的2年持续使用情况无统计学差异。年龄较大、自费或公共支付方保险（参考商业支付方）以及西班牙裔种族与2年持续使用相关。
四分之三使用宫内节育器或植入剂的女性会持续使用2年。在这个队列中，52毫克左炔诺孕酮宫内节育器、T380A铜宫内节育器和68毫克依托孕烯植入剂的2年持续使用率分别为77.8%、73.1%和75.9%。
