Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
J Adolesc Health. 2019 Feb;64(2):211-218. doi: 10.1016/j.jadohealth.2018.08.012. Epub 2018 Nov 2.
Adolescents may encounter many barriers to initiating contraception. 'Quick Start' is a recommended approach for initiating contraception on the same day as a provider visit. We examined factors associated with health care provider attitudes and practices related to 'Quick Start' provision of combined hormonal contraception (CHC) and depot medroxyprogesterone acetate (DMPA) to adolescents.
We analyzed weighted survey data from providers in publicly funded health centers and from office-based physicians (n = 2,056). Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the associations between provider characteristics and frequent (very often or often vs. not often or never) 'Quick Start' provision of CHC and DMPA to adolescents in the past year.
The prevalence of considering 'Quick Start' as safe was high for CHC (public-sector providers [87.5%]; office-based physicians [80.2%]) and DMPA (public-sector providers [80.9%]; office-based physicians [78.8%]). However, the prevalence of frequent 'Quick Start' provision was lower, particularly among office-based physicians (CHC: public-sector providers [74.2%]; office-based physicians [45.2%]; DMPA: public-sector providers [71.4%]; office-based physicians [46.9%]). Providers who considered 'Quick Start' unsafe or were uncertain about its safety had lower odds of frequent 'Quick Start' provision compared with those who considered it safe (public-sector providers: CHC aOR = 0.09 95% CI 0.06-0.13, DMPA aOR = 0.07 95% CI 0.05-0.10; office-based physicians: CHC aOR = 0.06 95% CI 0.02-0.22, DMPA aOR = 0.07 95% CI 0.02-0.20).
While most providers reported that 'Quick Start' initiation of CHC and DMPA among adolescents is safe, fewer providers reported frequent 'Quick Start' provision in this population, particularly among office-based physicians.
青少年在开始避孕时可能会遇到许多障碍。“快速启动”是一种推荐的方法,用于在与提供者就诊的同一天开始避孕。我们研究了与青少年提供联合激素避孕(CHC)和 depot 甲羟孕酮(DMPA)的“快速启动”相关的医疗保健提供者态度和实践相关的因素。
我们分析了来自公共资助医疗中心的提供者和办公室医生(n=2056)的加权调查数据。使用多变量逻辑回归,我们估计了提供者特征与在过去一年中经常(非常频繁或频繁与不频繁或从不频繁)向青少年提供 CHC 和 DMPA 的“快速启动”之间的关联的调整后优势比(aOR)和 95%置信区间(CI)。
对于 CHC(公共部门提供者[87.5%];办公室医生[80.2%])和 DMPA(公共部门提供者[80.9%];办公室医生[78.8%]),认为“快速启动”安全的比例很高。然而,“快速启动”的频繁提供率较低,特别是在办公室医生中(CHC:公共部门提供者[74.2%];办公室医生[45.2%];DMPA:公共部门提供者[71.4%];办公室医生[46.9%])。与认为安全的提供者相比,认为“快速启动”不安全或对其安全性不确定的提供者提供“快速启动”的可能性较低(公共部门提供者:CHC aOR=0.09 95%CI 0.06-0.13,DMPA aOR=0.07 95%CI 0.05-0.10;办公室医生:CHC aOR=0.06 95%CI 0.02-0.22,DMPA aOR=0.07 95%CI 0.02-0.20)。
虽然大多数提供者报告青少年中 CHC 和 DMPA 的“快速启动”启动是安全的,但较少的提供者报告在该人群中经常提供“快速启动”,特别是在办公室医生中。