J Midwifery Womens Health. 2019 Mar;64(2):225-229. doi: 10.1111/jmwh.12925. Epub 2018 Nov 16.
Many health care providers believe that women who initiate long-acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence-based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations.
A telephone triage guideline was adapted from the Contraceptive Choice Project's Clinician Call Back System, supplemented with evidence-based resources, and approved by clinicians at 2 community women's health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated.
Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation.
Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects.
许多医疗保健提供者认为，开始使用长效可逆避孕措施（LARC）的女性过早地因副作用而停止使用该方法，从而导致该方法不经济。本质量改进项目的目的是实施和评估一种基于证据的 LARC 副作用电话分诊护理指南，最终目标是减少早期停药的数量。
电话分诊指南改编自避孕选择项目的临床医生回拨系统，辅以基于证据的资源，并得到 2 个社区妇女健康和助产办公室的临床医生的批准。在实施指南之前的一年和实施后的 3 个月，对在这 2 个地点插入 LARC 的所有年龄在 18 岁以上的女性进行了回顾性基线数据收集。评估了在插入后 3 个月内或之前、在实施指南前后 LARC 取出的比率。
约有 1/5 的女性因管理 LARC 副作用而寻求帮助。在来电者中，接受标准护理的 32 名女性中有 3 名（9.4%）在 3 个月前停止使用 LARC，而使用指南分诊的 24 名女性中没有 1 名在 3 个月前停止使用 LARC（P=.12）。抽筋、出血、错位或排出是最常见的问题和停药的原因。
预期会有较少的女性来电报告副作用，但选择提前停止使用 LARC 的女性甚至更少。使用指南后停药的人数较少，但这没有统计学上的显著差异。大多数女性没有因任何原因（包括副作用）提前停止使用 LARC。
