Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341; Association of Schools and Programs of Public Health (Fellow), 1900 M Street NW, Suite 710, Washington, DC, United States, 20036.
Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341.
Contraception. 2019 May;99(5):300-305. doi: 10.1016/j.contraception.2019.01.005. Epub 2019 Feb 11.
Identify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents.
We analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year.
Although most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30-0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28-0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27-0.91) and family medicine (aOR 0.21, 95% CI 0.09-0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09-0.83), and reporting that 0-24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09-0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method.
While most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception.
Although >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.
确定与医疗保健提供者为青少年提供长效醋酸甲羟孕酮（DMPA）的频率相关的因素。
我们分析了向全国代表性的公共部门提供者和门诊医生样本（n=1984）邮寄调查的结果。我们估计了与过去一年中经常为青少年提供 DMPA 相关的因素的调整后比值比（aOR）和 95%置信区间（CI）。
尽管大多数提供者（>95%）认为 DMPA 对青少年是安全的，但报告经常提供的人数较少（公共部门提供者的 89%；门诊医生的 64%）。在公共部门的提供者中，与较低的经常提供 DMPA 的可能性相关的因素包括在没有 Title X 资金的环境中工作（aOR 0.44，95%CI 0.30-0.64），将初级保健作为主要临床重点而非生殖或青少年健康（aOR 0.42，95%CI 0.28-0.61），以及为较少的患者提供计划生育服务。在门诊医生中，与较低的经常提供 DMPA 的可能性相关的因素包括专门从事妇产科（aOR 0.50，95%CI 0.27-0.91）和家庭医学（aOR 0.21，95%CI 0.09-0.47）而不是青少年医学，完成培训≥15 年而非<5 年（aOR 0.27，95%CI 0.09-0.83），以及报告 0-24%的患者使用医疗补助或其他政府医疗保健援助支付费用，而不是≥50%（aOR 0.23，95%CI 0.09-0.61）。提供者报告的不经常提供 DMPA 的最常见原因是患者偏爱其他方法。
尽管大多数提供者报告经常为青少年提供 DMPA，但针对避孕的循证建议进行培训，重点关注不太可能经常提供 DMPA 的提供者亚组，可能会增加青少年获得避孕的机会。
尽管>95%的提供者认为长效甲羟孕酮（DMPA）是一种安全的青少年避孕药，但只有 89%的公共部门提供者和 64%的门诊医生报告经常为青少年提供 DMPA。针对避孕咨询和提供的循证建议进行提供者培训，可能会增加青少年获得 DMPA 和所有避孕方法的机会。
