Kang Minji Michelle, Guetterman Timothy C, Prussack Julie K, Ursu Allison, Wu Justine P
University of Michigan, Michigan Medicine, Department of Family Medicine, Ann Arbor, MI.
Fam Med. 2019 Jul;51(7):559-566. doi: 10.22454/FamMed.2019.499467.
Women with medical conditions are at higher risk of pregnancy-related morbidity and mortality than women without medical conditions. Thus, women who do not desire pregnancy should be offered contraceptive counseling and methods. The objective of this qualitative study was to identify potential best practices to guide primary care physicians (PCPs) in providing contraception and contraceptive counseling for women with medical conditions.
We conducted semistructured qualitative interviews of 10 PCPs who routinely provide contraception including long-acting reversible contraception (LARC). To inform the data collection and analysis, we adapted constructs from the Theoretical Domains Framework. We coded transcripts and identified themes until saturation of our theoretical constructs was achieved.
Physician time constraints, lack of patient knowledge, and competing demands related to medical condition management were identified as barriers to contraceptive care. The study participants reported multiple strategies to mitigate these barriers. They emphasized providing reproductive health education in the context of an individual's chronic conditions and medications, educating about LARC methods, and using the US Medical Eligibility Criteria (US MEC) as a point-of-care clinical tool to guide contraceptive selection.
The study participants (PCPs experienced in contraceptive care), described multifaceted approaches to providing contraception for women with medical conditions, including tailored contraceptive education and use of the US MEC for clinical guidance. Future research is needed to assess if such strategies can improve patient outcomes and be adopted by PCPs who have less experience with contraceptive care.
患有疾病的女性比未患疾病的女性在妊娠相关发病和死亡方面风险更高。因此，对于不希望怀孕的女性，应提供避孕咨询和方法。这项定性研究的目的是确定潜在的最佳实践，以指导初级保健医生（PCP）为患有疾病的女性提供避孕和避孕咨询。
我们对10名常规提供避孕服务（包括长效可逆避孕法[LARC]）的初级保健医生进行了半结构化定性访谈。为了为数据收集和分析提供信息，我们采用了理论领域框架中的概念。我们对访谈记录进行编码并确定主题，直到我们的理论概念达到饱和。
医生的时间限制、患者知识的缺乏以及与疾病管理相关的相互竞争的需求被确定为避孕护理的障碍。研究参与者报告了多种减轻这些障碍的策略。他们强调在个人慢性病和药物治疗的背景下提供生殖健康教育，对长效可逆避孕法进行教育，并将美国医学适用性标准（US MEC）作为即时临床工具来指导避孕选择。
研究参与者（有避孕护理经验的初级保健医生）描述了为患有疾病的女性提供避孕的多方面方法，包括量身定制的避孕教育和使用美国医学适用性标准进行临床指导。未来需要进行研究，以评估这些策略是否能改善患者结局，并被避孕护理经验较少的初级保健医生采用。
