Evans Megan L, Breeze Janis L, Paulus Jessica K, Meadows Audra
Department of Obstetrics and Gynecology (Dr Evans) and Institute for Clinical Research and Health Policy Studies (Ms Breeze), Tufts Medical Center, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts (Ms Breeze); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts (Dr Paulus); and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Meadows).
J Public Health Manag Pract. 2017 Nov/Dec;23(6):684-689. doi: 10.1097/PHH.0000000000000607.
The aim of this study was to assess the impact of a revolving loan fund (RLF) on timing of device insertion and long-acting reversible contraception (LARC) access among a high-risk urban population at 3 Boston community health centers.
Three health centers were identified to implement a RLF. Each clinic received $5000 from the RLF to purchase LARC devices. Data collected through medical record review retrospectively 1 year prior to start of the RLF and prospectively for 1 year thereafter included patient demographics, type of LARC selected, patient's date of documented interest in a LARC device, and date of insertion. The effect of a RLF on delay to LARC insertion was tested using negative binomial regression, controlling for site and potential confounding variables between the pre- and post-RLF periods.
Three urban community health centers.
Reproductive-aged women who received family planning services at the 3 participating health centers.
Increasing access to LARC and decreasing wait times to LARC insertion after implementation of the RLF.
Data on 133 patients in the pre-RLF group and 205 in the post-RLF group were collected. There were no statistically significant differences in demographic or clinical characteristics between the 2 time periods. LARC uptake increased significantly from the pre- to post-RLF period, specifically among implant users. There was a statistically significant decrease in the mean number of days in delay from interest to insertion from the pre- to post-RLF period (pre-RLF: 31.3 ± 50.6 days; post-RLF: 13.6 ± 16.7 days, adjusted P < .001). The reasons for the delay did not differ significantly between the 2 time periods.
The RLF decreased wait time for the devices and increased overall insertion rates. This may serve as a promising solution to improve LARC access in community health centers. This project could be expanded to include more health centers, creating a city wide RLF. This expansion could allow for further data analysis, including unintended pregnancy rates with LARC delay, LARC continuation rates, and sustainability of a RLF.
本研究旨在评估循环贷款基金（RLF）对波士顿3家社区卫生中心高危城市人群中长效可逆避孕方法（LARC）的植入时机和获取情况的影响。
选定3家卫生中心实施RLF。每家诊所从RLF获得5000美元用于购买LARC设备。通过病历回顾收集的数据包括RLF开始前1年的回顾性数据以及此后1年的前瞻性数据，涵盖患者人口统计学信息、所选LARC类型、患者记录对LARC设备感兴趣的日期以及植入日期。使用负二项回归测试RLF对延迟LARC植入的影响，并控制RLF前后时期的地点和潜在混杂变量。
3家城市社区卫生中心。
在3家参与研究的卫生中心接受计划生育服务的育龄妇女。
实施RLF后增加LARC的获取并减少LARC植入的等待时间。
收集了RLF前组133例患者和RLF后组205例患者的数据。两个时期的人口统计学或临床特征无统计学显著差异。从RLF前到RLF后时期，LARC的采用率显著增加，特别是在植入使用者中。从RLF前到RLF后时期，从感兴趣到植入的平均延迟天数有统计学显著减少（RLF前：31.3±50.6天；RLF后：13.6±16.7天，校正P<.001）。两个时期延迟的原因无显著差异。
RLF减少了设备的等待时间并提高了总体植入率。这可能是改善社区卫生中心LARC获取情况的一个有前景的解决方案。该项目可扩展到包括更多卫生中心，创建一个全市范围的RLF。这种扩展可以进行进一步的数据分析，包括LARC延迟导致的意外怀孕率、LARC持续率以及RLF的可持续性。
