Division of Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005, St. Louis, MO 63108, USA.
Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005, St. Louis, MO 63108, USA.
Contraception. 2019 Sep;100(3):196-201. doi: 10.1016/j.contraception.2019.05.009. Epub 2019 May 24.
To compare unintended pregnancy rates at 12 months between women receiving structured contraceptive counseling plus usual contraceptive care and women receiving structured contraceptive counseling, healthcare provider education and cost support for long-acting reversible contraceptive (LARC) methods.
Using a controlled time-trend study design, we first enrolled 502 women receiving structured contraceptive counseling in addition to usual care ("Enhanced Care") and subsequently enrolled 506 women receiving counseling plus healthcare provider education and cost support for LARC methods ("Complete CHOICE") at three federally qualified health centers (FQHCs). Cost support included funds to health centers for "on-the-shelf" LARC methods and no-cost LARC methods for uninsured women. Participants completed in-person baseline surveys and follow-up surveys by telephone at 3, 6 and 12 months. We used Kaplan-Meier survival function to estimate 12-month unintended pregnancy rates and Cox proportional-hazards regression to compare unintended pregnancy rates between the two groups. We imputed pregnancy outcomes for women lost to follow-up (9%) prior to 12 months.
"Complete CHOICE" participants were less likely to report an unintended pregnancy at 12 months compared to "Enhanced Care"; 5.3 vs. 9.8 pregnancies per 100 women-years (p=.01). After adjusting for confounders (recruitment site, race, age and federal poverty level), women in "Complete CHOICE" had a 40% lower risk of unintended pregnancy at 12 months (adjusted hazard ratio 0.60; 95% confidence interval 0.37-0.99).
Contraceptive provision that includes cost support and healthcare provider education in addition to patient counseling reduced unintended pregnancy at 12 months compared to counseling plus usual contraceptive care.
A program of contraceptive care that includes comprehensive counseling; healthcare provider education; cost support; and on-the-shelf, long-acting reversible contraception can reduce unintended pregnancy compared to contraceptive counseling in addition to usual health center care in the FQHC setting.
比较接受结构化避孕咨询加常规避孕护理的女性与接受结构化避孕咨询、医护人员教育和长效可逆避孕（LARC）方法费用支持的女性在 12 个月时的意外妊娠率。
使用控制时间趋势研究设计，我们首先在三个联邦合格健康中心（FQHC）招募了 502 名接受结构化避孕咨询以及常规护理的女性（“强化护理”），随后招募了 506 名接受咨询以及医护人员教育和 LARC 方法费用支持的女性（“完整 CHOICE”）。费用支持包括为 FQHC 提供 LARC 方法的“现货”资金以及为没有保险的女性提供免费的 LARC 方法。参与者通过面对面基线调查和电话随访在 3、6 和 12 个月时完成随访。我们使用 Kaplan-Meier 生存函数估计 12 个月的意外妊娠率，并使用 Cox 比例风险回归比较两组之间的意外妊娠率。我们对在 12 个月前失访（9%）的女性进行了妊娠结局的推断。
与“强化护理”相比，“完整 CHOICE”参与者在 12 个月时报告意外妊娠的可能性较低，每 100 名女性年中有 5.3 例（9.8）妊娠（p=.01）。在调整混杂因素（招募地点、种族、年龄和联邦贫困水平）后，“完整 CHOICE”组女性在 12 个月时意外妊娠的风险降低了 40%（调整后的危险比 0.60；95%置信区间 0.37-0.99）。
与咨询加常规避孕护理相比，包括成本支持和医护人员教育的避孕服务增加了 12 个月时的意外妊娠率。
与在 FQHC 环境中除常规健康中心护理外增加避孕咨询相比，包括全面咨询、医护人员教育、成本支持和现货长效可逆避孕的避孕护理方案可以降低意外妊娠率。
