1 Las Vegas Minimally Invasive Surgery and Women's Pelvic Health Center , Las Vegas, Nevada.
2 Department of Molecular, Cellular and Developmental Biology, University of Colorado , Boulder, Colorado.
J Womens Health (Larchmt). 2018 Feb;27(2):191-195. doi: 10.1089/jwh.2017.6468. Epub 2017 Oct 4.
To assess temporal trends in the uptake and continuation of the etonogestrel subdermal implant in a large private practice setting.
This was a retrospective cohort study based on billing records from a large multispecialty private practice in Las Vegas, Nevada. We looked at women of all ages seeking long-acting reversible contraception (LARC) between January 1, 2013, and December 31, 2016. The main outcome measure was uptake of the etonogestrel subdermal implant, expressed as a fraction of all insertions of LARC across four calendar years (2013-2016). The Kaplan-Meier method was used to estimate 12-month continuation stratified by year of insertion.
There were 3477 total LARC insertions across the 4-year study period. In unadjusted analyses, the uptake of the etonogestrel implant increased from 3.0% of LARC insertions in 2013 to 9% in 2016 among women aged 30 years and older. For women younger than 30 years, the uptake of the implant stayed stable from 2013 to 2015 (22.8%, 21.7%, and 22.4%, respectively), but increased to 30.9% in 2016. We modeled the uptake of the implant as a function of year of insertion adjusted for age (continuous) and insurance status (private vs. Medicaid), and we stratified the models by age (younger than 30 years, 30 years, and older than 30 years). The positive association between year of insertion and uptake of the implant was significantly stronger for women aged 30 years and older, compared to women younger than 30 years. There was a progressive decrease in the 12-month continuation of implant from 2013 (95.7%) to 2015 (57.7%).
In this large private practice setting, among women aged 30 years and older, we observed a threefold increase in the uptake of the subdermal implant from 2013 to 2016. We also observed a significant decrease in the 12-month continuation of the implant over time. Further studies of implant uptake and continuation in the private practice setting are needed.
在一个大型私人诊所环境中评估依托孕诺酮皮下埋植剂的使用和持续使用情况的时间趋势。
这是一项基于内华达州拉斯维加斯一家多专科大型私人诊所的计费记录的回顾性队列研究。我们研究了 2013 年 1 月 1 日至 2016 年 12 月 31 日期间所有寻求长效可逆避孕（LARC）的年龄段女性。主要结局测量指标是依托孕诺酮皮下埋植剂的使用情况，以四年（2013-2016 年）内所有 LARC 插入物的分数表示。Kaplan-Meier 法用于按插入年份分层估计 12 个月的持续率。
在四年的研究期间，共有 3477 例总 LARC 插入。在未调整的分析中，30 岁及以上女性的依托孕诺酮植入物使用率从 2013 年的 LARC 插入物的 3.0%增加到 2016 年的 9%。对于 30 岁以下的女性，植入物的使用率从 2013 年到 2015 年保持稳定（分别为 22.8%、21.7%和 22.4%），但 2016 年增加到 30.9%。我们将植入物的使用率建模为调整年龄（连续）和保险状况（私人保险与医疗补助）的插入年份的函数，并按年龄（30 岁以下、30 岁及以上）对模型进行分层。与 30 岁以下的女性相比，30 岁及以上女性的植入物使用率与插入年份之间的正相关关系要强得多。从 2013 年（95.7%）到 2015 年（57.7%），植入物的 12 个月持续率呈逐渐下降趋势。
在这个大型私人诊所环境中，我们观察到 30 岁及以上女性的皮下埋植剂使用率从 2013 年到 2016 年增加了两倍。我们还观察到，随着时间的推移，植入物的 12 个月持续率显著下降。需要进一步研究私人诊所环境中植入物的使用和持续情况。
