University of California San Francisco School of Medicine, San Francisco, CA, USA.
University of California San Francisco School of Pharmacy, San Francisco, CA, USA.
Contraception. 2020 Dec;102(6):392-395. doi: 10.1016/j.contraception.2020.09.001. Epub 2020 Sep 12.
To describe the implementation and results of a proactive patient outreach project to offer self-administered, depot medroxyprogesterone (DMPA) subcutaneous (SC) to interested patients at a California safety-net clinic following expanded state Medicaid coverage.
We contacted non-pregnant patients at an urban, safety-net hospital-based primary care clinic who had been prescribed DMPA intramuscular (IM) in the past year to gauge interest in self-administered DMPA-SC. Interested patients received a prescription for DMPA-SC and a telehealth appointment with a clinic provider to learn self-injection. We recorded patient interest in DMPA-SC, completed appointments, and completed first injections. We conducted initial outreach in May, 2020 and recorded appointment attendance and completed injections through August, 2020.
Of 90 eligible patients (age 17-54), we successfully contacted and discussed DMPA-SC with 70 (78%). Twenty-six (37%) patients expressed interest in DMPA-SC and scheduled telehealth appointments to learn to self-administer the medication. Fifteen (58%) of those interested (21% of the total) successfully self-injected DMPA-SC. Of the 44 (63%) patients not interested in DMPA-SC, the three most common reasons were fear of self-injection (n = 23 [52%]), wanting to stop DMPA (n = 11 [25%]), and satisfaction with DMPA-IM (n = 6 [14%]).
There is interest in and successful initiation of self-administered DMPA-SC among patients at an urban safety net hospital-based primary care clinic who have used DMPA-IM in the last year.
Our data provide evidence for the interest and successful first injection rate after offering self-administered DMPA-SC to patients on DMPA-IM. Expanding coverage of self-administered DMPA-SC could increase patient-centeredness and accessibility of contraception as well as reduce patient anxiety around COVID-19 transmission without losing contraceptive access.
描述在加利福尼亚州扩大医疗补助计划覆盖范围后，为一家加州医疗保障机构中的一位有兴趣的患者提供自我管理的长效醋酸甲羟孕酮（DMPA）皮下注射的主动患者外展项目的实施和结果。
我们联系了过去一年在一家城市、医疗保障机构为主的初级保健诊所中接受过肌内 DMPA 处方的非孕妇患者，以评估他们对自我管理 DMPA-SC 的兴趣。有兴趣的患者收到了 DMPA-SC 的处方和与诊所提供者进行远程医疗预约，以了解自我注射。我们记录了患者对 DMPA-SC 的兴趣、完成预约和首次注射的情况。我们于 2020 年 5 月首次进行外展，并记录了 2020 年 8 月的预约出席和完成注射情况。
在 90 名符合条件的患者（年龄 17-54 岁）中，我们成功联系并讨论了 70 名（78%）患者的 DMPA-SC。26 名（37%）患者对 DMPA-SC 感兴趣，并预约远程医疗学习自我给药。15 名（58%）感兴趣的患者（总人数的 21%）成功自我注射了 DMPA-SC。在 44 名（63%）不感兴趣的患者中，最常见的三个原因是害怕自我注射（n=23 [52%]）、想要停止使用 DMPA（n=11 [25%]）和对 DMPA-IM 满意（n=6 [14%]）。
在过去一年中使用 DMPA-IM 的城市医疗保障机构为主的初级保健诊所的患者中，对自我管理的 DMPA-SC 有兴趣并成功开始首次注射。
我们的数据为向使用 DMPA-IM 的患者提供自我管理的 DMPA-SC 后，对其的兴趣和首次注射率提供了证据。扩大自我管理的 DMPA-SC 的覆盖范围，可以增加以患者为中心和避孕的可及性，同时减少 COVID-19 传播方面的患者焦虑，而不会失去避孕机会。
