将计划生育服务纳入艾滋病护理：在马拉维利隆圭使用即时医疗电子病历系统
Integrating family planning services into HIV care: use of a point-of-care electronic medical record system in Lilongwe, Malawi.
作者信息
Tweya Hannock, Feldacker Caryl, Haddad Lisa B, Munthali Chimango, Bwanali Mwatha, Speight Colin, Kachere Layout G, Tembo Petros, Phiri Sam
机构信息
a Center for Operational Research, The International Union Against Tuberculosis and Lung Disease , Paris , France.
b Monitoring and Evaluation Department, Lighthouse Trust , Lilongwe , Malawi.
出版信息
Glob Health Action. 2017;10(1):1383724. doi: 10.1080/16549716.2017.1383724.
BACKGROUND
Integrating family planning (FP) services into human immunodeficiency virus (HIV) clinical care helps improve access to contraceptives for women living with HIV. However, high patient volumes may limit providers' ability to counsel women about pregnancy risks and contraceptive options.
OBJECTIVES
To assess trends in the use of contraceptive methods after implementing an electronic medical record (EMR) system with FP questions and determine the reasons for non-use of contraceptives among women of reproductive age (15-49 years) receiving antiretroviral therapy (ART) at the Martin Preuss Center clinic in Malawi.
METHODS
In February 2012, two FP questions were incorporated into the ART EMR system (initial FP EMR module) to prompt providers to offer contraceptives to women. In July 2013, additional questions were added to the FP EMR module (enhanced FP EMR) to prompt providers to assess risks of unintended pregnancies, solicit reasons for non-use of contraceptives and offer contraceptives to non-pregnant women . We conducted a retrospective, longitudinal cohort study using the EMR routinely collected data. The primary outcome was the use of any modern contraceptive method. Descriptive statistics were used to describe the study population and report trends in contraceptive use during the initial and enhanced study periods.
RESULTS
Between February 2012 and December 2016, in HIV clinics, 20,253 women of reproductive age received ART, resulting in 163,325 clinic visits observations. The proportion of women using contraceptives increased significantly from 18% to 39% between February 2012 and June 2013, and from 39% to 67% between July 2013 and December 2016 (chi-square for trend p < 0.001). Common reasons reported for the non-use of contraceptives among those at risk of unintended pregnancy were: pregnancy ambivalence (n = 234, 51%) and never thought about it (n = 133, 29%).
CONCLUSION
Incorporating the FP EMR module into HIV clinical care prompted healthcare workers to encourage the use of contraceptives.
背景
将计划生育（FP）服务纳入人类免疫缺陷病毒（HIV）临床护理有助于改善HIV感染女性获得避孕药具的机会。然而，患者数量众多可能会限制医护人员为女性提供怀孕风险咨询和避孕选择建议的能力。
目的
评估在实施带有FP问题的电子病历（EMR）系统后避孕方法的使用趋势，并确定在马拉维马丁·普吕斯中心诊所接受抗逆转录病毒治疗（ART）的育龄（15 - 49岁）女性不使用避孕药具的原因。
方法
2012年2月，两个FP问题被纳入ART EMR系统（初始FP EMR模块），以促使医护人员为女性提供避孕药具。2013年7月，更多问题被添加到FP EMR模块（增强型FP EMR），以促使医护人员评估意外怀孕风险、询问不使用避孕药具的原因并为未怀孕女性提供避孕药具。我们使用EMR常规收集的数据进行了一项回顾性纵向队列研究。主要结局是使用任何现代避孕方法。描述性统计用于描述研究人群并报告初始研究期和增强研究期内避孕使用的趋势。
结果
2012年2月至2016年12月期间，在HIV诊所，20253名育龄女性接受了ART治疗，产生了163325次门诊观察记录。2012年2月至2013年6月期间，使用避孕药具的女性比例从18%显著增加到39%，2013年7月至2016年12月期间从39%增加到67%（趋势卡方检验p < 0.001）。在有意外怀孕风险的人群中，报告的不使用避孕药具的常见原因是：对怀孕矛盾（n = 234，51%）和从未考虑过（n = 133，29%）。
结论
将FP EMR模块纳入HIV临床护理促使医护人员鼓励使用避孕药具。
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