Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005St. Louis, Missouri 63108.
College of Global Public Health, New York University, 715 Broadway, 10(th) Floor, New York, NY 10003.
Contraception. 2019 Apr;99(4):222-227. doi: 10.1016/j.contraception.2018.12.005. Epub 2019 Jan 24.
To compare the proportion of women receiving same-day long-acting reversible contraception (LARC) between two different models of contraceptive provision adapted from the Contraceptive CHOICE Project.
We used a controlled time-trend study design to compare 502 women receiving structured contraceptive counseling in addition to usual care ("Enhanced Care") to 506 women receiving counseling plus healthcare provider education and cost support for LARC ("Complete CHOICE") at three federally qualified health centers. We provided funds to health centers to ensure an "on-the-shelf" supply and no-cost LARC for uninsured women. We recorded the contraceptive method chosen after contraceptive counseling and the healthcare provider appointment as well as the contraceptive method received that day. Among women choosing LARC, we calculated proportions and performed Poisson regression with robust error variance to estimate relative risks for same-day insertion.
Participant demographics reflected the health center populations; 69% were black, 66% had a high school diploma or less, 57% were publicly insured, and 75% reported household income less than 101% federal poverty line. There were 153 (30.5%) women in "Enhanced Care" and 273 (54.0%) in "Complete CHOICE" who chose LARC (p<0.01). Among women who chose LARC (n=426), those in "Complete CHOICE" were more likely to receive a same-day insertion, 53.8% vs. 13.7% (RR 4.73; 95%CI 3.20-6.98) compared to "Enhanced Care."
A contraceptive care model that included healthcare provider education and cost support for LARC in addition to structured contraceptive counseling resulted in higher rates of same-day LARC insertion compared to contraceptive counseling and usual care alone.
Contraceptive care provision which includes contraceptive counseling, healthcare provider education, and "on-the-shelf", long-acting reversible contraception facilitate same-day initiation of these methods. Interventions that focus solely on contraceptive counseling do not address other structural barriers to same-day contraceptive provision of all methods including cost and provider practice.
比较两种源自避孕选择项目的不同避孕提供模式下，当天接受长效可逆避孕（LARC）的女性比例。
我们采用对照时间趋势研究设计，在三个联邦合格健康中心比较了 502 名接受结构化避孕咨询和常规护理（“强化护理”）的女性，以及 506 名接受咨询和医疗保健提供者教育以及 LARC 成本支持（“完整选择”）的女性。我们向健康中心提供资金，以确保为未参保女性提供“货架上”供应和免费 LARC。我们记录了避孕咨询和医疗保健提供者预约后选择的避孕方法以及当天接受的避孕方法。在选择 LARC 的女性中，我们计算了比例并进行了泊松回归分析，以估计当天放置的相对风险。
参与者人口统计学特征反映了健康中心人群；69%为黑人，66%具有高中文凭或以下学历，57%受公共保险覆盖，75%报告家庭收入低于联邦贫困线的 101%。在“强化护理”中有 153 名（30.5%）女性和“完整选择”中有 273 名（54.0%）女性选择了 LARC（p<0.01）。在选择 LARC 的女性中（n=426），与“强化护理”相比，“完整选择”组中更有可能接受当天放置，53.8%比 13.7%（RR 4.73；95%CI 3.20-6.98）。
除了结构化避孕咨询外，提供包含医疗保健提供者教育和 LARC 成本支持的避孕护理模式与单独提供避孕咨询和常规护理相比，更有可能增加当天放置 LARC 的比例。
提供包括避孕咨询、医疗保健提供者教育和“货架上”长效可逆避孕在内的避孕护理服务，可以促进这些方法的当天启动。仅关注避孕咨询的干预措施并不能解决所有方法（包括成本和提供者实践）当天避孕提供的其他结构性障碍。
