Planned Parenthood Federation of America, New York, NY, USA.
Planned Parenthood Federation of America, New York, NY, USA.
Contraception. 2020 Jan;101(1):14-20. doi: 10.1016/j.contraception.2019.10.003. Epub 2019 Oct 23.
Systematic reviews of contraceptive counseling interventions have shown inconsistent impact on patient outcomes. The current study assessed the effects of an evidence-informed contraceptive counseling staff training intervention on patient experience, contraceptive selection, and behavior over three months of follow-up.
We randomly assigned 10 Planned Parenthood health centers in the Southeastern US to intervention (staff received contraceptive counseling training) and control (usual counseling) groups. From December 2016-June 2017, patients completed surveys immediately post visit (n = 756) and one and three months after. We compared differences in patients' counseling experience (e.g., number of evidence-informed practices experienced, satisfaction with counseling), contraceptive selection, and behavior (e.g., method discontinuation, accurate pill use, condom use) between study groups using mixed effect models with health center specified as a random effect.
Seven hundred and fifty-six participants completed the baseline survey; 579 (77%) completed one or both follow-up surveys. The intervention group was more likely to report experiencing all evidence-informed counseling practices (adj. Prevalence Ratio [aPR] = 2.27, 95% CI 1.27, 4.04) with less variation in the number of practices and higher satisfaction with their counseling than the control group (p < 0.01). We found no sustained differences in contraceptive behaviors at both one- and three-month follow-up.
We found immediate positive effects of the intervention on patients' perceptions of their counseling experience and no differences in changes in contraceptive behavior over time between the study groups.
Evidence-based strategies to improve the quality of contraceptive care and subsequent outcomes, while centering patients' needs and preferences, are needed. The contraceptive counseling intervention offers a tool for increasing consistency in contraceptive counseling practices across health centers and improving patient satisfaction.
系统评价避孕咨询干预措施的结果显示，其对患者结局的影响不一致。本研究评估了一项基于证据的避孕咨询员工培训干预措施对患者体验、避孕方法选择和行为的影响，随访时间为 3 个月。
我们随机分配美国东南部 10 家计划生育协会健康中心进入干预（员工接受避孕咨询培训）和对照组（常规咨询）。2016 年 12 月至 2017 年 6 月，患者在就诊后立即（n=756）和 1 个月和 3 个月后完成调查。我们使用混合效应模型比较了两组患者咨询体验（例如，体验的证据支持实践的数量、对咨询的满意度）、避孕方法选择和行为（例如，方法停用、正确使用避孕药、使用避孕套）的差异，健康中心被指定为随机效应。
756 名参与者完成了基线调查；579 名（77%）完成了一次或两次随访调查。干预组更有可能报告体验到所有证据支持的咨询实践（调整后的流行率比[aPR]为 2.27，95%可信区间为 1.27-4.04），实践数量的变化较小，对咨询的满意度较高，与对照组相比（p<0.01）。我们在 1 个月和 3 个月的随访中均未发现避孕行为持续存在差异。
我们发现干预措施对患者对咨询体验的看法有直接的积极影响，且两组患者在避孕行为的变化上没有随时间的差异。
需要采取以证据为基础的策略来提高避孕护理的质量和随后的结果，同时以患者的需求和偏好为中心。避孕咨询干预措施提供了一种工具，可以提高卫生中心避孕咨询实践的一致性，并提高患者满意度。
