Cowen Lauren, Hartman Scott G, Loomis Elizabeth, Srinivasan Sukanya, Gasbarro Christina, Young Jocelyn
University of Rochester Family Medicine Residency, Rochester, NY.
University of Rochester Medical Center, Rochester, NY.
PRiMER. 2019 Feb 8;3:2. doi: 10.22454/PRiMER.2019.228141. eCollection 2019.
Short interpregnancy periods increase the likelihood of preterm delivery and low birth weight,1 both of which are significant causes of infant morbidity and mortality.2 Since nearly half of pregnancies in the United States are unplanned,3 opportunities exist to better understand barriers to contraceptive services. Studying these barriers as perceived by clinical staff can better guide programs to improve interpregnancy spacing.
Between September and November 2017, 76 staff and 95 primary care clinicians from two family medicine residency practices (Highland Family Medicine (HFM) in Rochester, New York and St Margaret Family Medicine (SM) in Pittsburgh, Pennsylvania) completed surveys. Questions assessed perceived barriers to providing contraceptive services, contraception knowledge, and opportunities for improvement. Survey-based analysis focused on comparative descriptive statistics between staff and provider responses.
Clinicians ranked side effects and patient lack of awareness and misconceptions about contraceptive methods more highly than staff (=0.0073 and =0.0001, respectively). Staff identified childcare and work absence as more significant barriers (=0.0114 and =0.0380, respectively). Providers felt appointment timing was the largest constraint to contraceptive care. Staff perceived financial limitations and scheduling to be the top barriers. Nonclinician staff exhibited significant knowledge gaps regarding contraception.
Numerous modifiable barriers contribute to difficulty providing contraceptive services. Providers and staff largely agree on the perceived barriers, but there is a significant gap in nonclinician staff knowledge of contraception. Education can address one of the leading concerns, but improvement efforts should also address areas such as availability of devices, scheduling issues, and resident supervision.
妊娠间隔时间短会增加早产和低出生体重的可能性，这两者都是婴儿发病和死亡的重要原因。由于美国近一半的怀孕是意外怀孕，因此有机会更好地了解避孕服务的障碍。研究临床工作人员所感知的这些障碍可以更好地指导相关项目改善妊娠间隔。
2017年9月至11月期间，来自两家家庭医学住院医师培训机构（纽约罗切斯特的高地家庭医学（HFM）和宾夕法尼亚州匹兹堡的圣玛格丽特家庭医学（SM））的76名工作人员和95名初级保健临床医生完成了调查。问题评估了提供避孕服务的感知障碍、避孕知识以及改进机会。基于调查的分析重点关注工作人员和提供者回答之间的比较描述性统计。
临床医生认为副作用以及患者对避孕方法缺乏认识和误解比工作人员更为突出（分别为P=0.0073和P=0.0001）。工作人员认为儿童保育和工作缺勤是更重要的障碍（分别为P=0.0114和P=0.0380）。提供者认为预约时间是避孕护理的最大限制。工作人员认为经济限制和安排是首要障碍。非临床工作人员在避孕知识方面存在显著差距。
众多可改变的障碍导致提供避孕服务困难。提供者和工作人员在感知到的障碍方面基本达成一致，但非临床工作人员在避孕知识方面存在显著差距。教育可以解决主要问题之一，但改进工作还应解决诸如设备可用性、安排问题和住院医师监督等领域的问题。
