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在减少伤害框架下接受培训的药剂师能够安全有效地提供药物流产服务:尼泊尔。

Medical abortion can be provided safely and effectively by pharmacy workers trained within a harm reduction framework: Nepal.

作者信息

Tamang Anand, Puri Mahesh, Masud Sazina, Karki Deepak Kumar, Khadka Diksha, Singh Minal, Sharma Poonam, Gajurel Subash

机构信息

Center for Research on Environment Health and Population Activities (CREHPA), Kusunti, Lalitpur-13, P.O. Box 9626, Kathmandu, Nepal.

Center for Research on Environment Health and Population Activities (CREHPA), Kusunti, Lalitpur-13, P.O. Box 9626, Kathmandu, Nepal.

出版信息

Contraception. 2018 Feb;97(2):137-143. doi: 10.1016/j.contraception.2017.09.004. Epub 2017 Sep 18.

Abstract

OBJECTIVES

To examine the treatment efficacy, safety and satisfaction of women using medical abortion (MA) pills provided by pharmacists following an education intervention based on a harm reduction approach.

STUDY DESIGN

This was an operations research study over a six-month period in 2015, using a non-inferiority design. We provided training to dispense MA pills, based on a harm reduction approach, to a group of pharmacy workers in Makwanpur district (GROUP 2). We compared selected outcomes with women who bought the pills from pharmacy workers in Chitwan district (GROUP 1), who had received similar training in 2010. The primary endpoint measured in 992 women in both districts was complete abortion within 30 days of using the pills. We assessed the efficacy of MA (self-reported complete abortion) and safety (no reported adverse event). To determine complete abortion, we asked women about passage of the products of conception, cessation of abdominal cramps, vaginal bleeding, need for manual vacuum aspiration or repeated doses of misoprostol. We used a four-point Lickert Scale to determine level of satisfaction with MA use. Pearson Chi-Square test was used to examine any differences in proportion of complete abortions between women who were served by the two groups of pharmacy workers.

RESULTS

The difference in the rate of complete abortions between the two groups of women, 96.9% and 98.8%, was not statistically significant. The women reported no serious complications, and there was little difference in their satisfaction levels.

CONCLUSIONS

Trained pharmacy workers dispensed MA safely and effectively to the satisfaction of almost all women clients, and the positive results of training had continued several years later.

IMPLICATIONS

The role of pharmacy workers as providers of correct and complete information on safe and effective use of MA needs to be recognized and policies formulated to allow them to provide MA drugs for first trimester use.

摘要

目的

探讨在基于减少伤害方法的教育干预后,使用药剂师提供的药物流产(MA)药的女性的治疗效果、安全性和满意度。

研究设计

这是一项在2015年为期六个月的行动研究,采用非劣效性设计。我们基于减少伤害方法,为马克万布尔区的一组药房工作人员提供了发放MA药的培训(第2组)。我们将选定的结果与从奇旺区药房工作人员处购买药物的女性(第1组)进行了比较,这些女性在2010年接受过类似培训。在两个区的992名女性中测量的主要终点是服药后30天内完全流产。我们评估了MA的效果(自我报告的完全流产)和安全性(无不良事件报告)。为确定完全流产,我们询问女性关于妊娠产物排出、腹部绞痛停止、阴道出血情况、是否需要人工负压吸引或重复服用米索前列醇。我们使用四点李克特量表来确定对MA使用的满意度水平。使用Pearson卡方检验来检查两组药房工作人员服务的女性之间完全流产比例的差异。

结果

两组女性的完全流产率分别为96.9%和98.8%,差异无统计学意义。这些女性未报告严重并发症,她们的满意度水平差异不大。

结论

经过培训的药房工作人员安全有效地发放MA药,几乎所有女性客户都感到满意,而且培训的积极效果在数年后仍在持续。

启示

需要认识到药房工作人员作为安全有效使用MA的正确和完整信息提供者的作用,并制定政策允许他们提供用于孕早期的MA药物。

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