Goldstein Rachel L, Carlson Jennifer L, Halpern-Felsher Bonnie
Division of Adolescent Medicine, Stanford University, Palo Alto, California
Division of Adolescent Medicine, Stanford University, Palo Alto, California.
Hosp Pediatr. 2018 Apr;8(4):194-199. doi: 10.1542/hpeds.2017-0167. Epub 2018 Mar 1.
To assess pediatric providers' attitudes and barriers to initiating a contraceptive method in the inpatient setting.
Pediatric attending physicians and trainees from 5 academic institutions were surveyed about contraceptive prescribing practices, attitudes, and potential barriers to initiating contraception in the inpatient setting.
In 2016, 271 pediatric providers (34.0% were attending physicians, 18.1% fellows, and 47.9% residents) completed the survey; the response rate was 19.2%. Most participants practiced in both inpatient and outpatient settings (95.7% and 85.0%, respectively). More providers felt confident screening for sexual activity among young adults as compared with adolescents (71.9% vs 65.6%). The same was true for discussing contraceptive options (44.0% vs 38.8%, respectively). Inpatient providers reported seeing adolescents and young adults privately, discussing confidentiality, and asking about sex less than half of the time. More than 80% of providers agreed that it would be appropriate to initiate a contraceptive method for inpatients; 35.8% had done so, and 85.2% indicated that having additional consultation would increase initiation of a contraceptive method in the hospital (88.1% felt similarly for long-active reversible contraception methods). General barriers to initiating contraception included insufficient training, insufficient exposure to adolescents and young adults to maintain skills, and lack of time. Barriers specific to the inpatient setting included concerns about follow-up, confidentiality, and interference with the treatment plan.
Initiation of a contraceptive method in the inpatient setting is acceptable to providers. In our findings, it is suggested that strategies are needed to enhance provision of these services by addressing confidentiality concerns and educating providers.
评估儿科医疗服务提供者在住院环境中启动避孕方法的态度和障碍。
对来自5个学术机构的儿科主治医师和实习生进行了调查，内容包括避孕处方实践、态度以及在住院环境中启动避孕措施的潜在障碍。
2016年，271名儿科医疗服务提供者（34.0%为主治医师，18.1%为研究员，47.9%为住院医师）完成了调查；回复率为19.2%。大多数参与者在住院和门诊环境中都有工作经历（分别为95.7%和85.0%）。与青少年相比，更多的医疗服务提供者对筛查年轻人的性活动更有信心（71.9%对65.6%）。讨论避孕选择的情况也是如此（分别为44.0%对38.8%）。住院医疗服务提供者报告说，他们不到一半的时间会私下会见青少年和年轻人、讨论保密性以及询问性方面的问题。超过80%的医疗服务提供者认为为住院患者启动避孕方法是合适的；35.8%的人已经这样做了，85.2%的人表示增加额外的咨询会增加医院中避孕方法的启动（88.1%的人对长效可逆避孕方法也有类似看法）。启动避孕措施的一般障碍包括培训不足、接触青少年和年轻人的机会不足以维持技能以及时间不足。住院环境特有的障碍包括对随访、保密性以及对治疗计划的干扰的担忧。
医疗服务提供者认为在住院环境中启动避孕方法是可以接受的。根据我们的研究结果，建议需要采取策略来解决保密性问题并对医疗服务提供者进行教育，以加强这些服务的提供。
