Blair G. Darney and Maria I. Rodriguez are with the Department of Obstetrics and Gynecology, Oregon Health & Science University (OHSU), Portland. Blair G. Darney is also with Health Systems & Policy, OHSU-Portland State University joint School of Public Health. Frances M. Biel, Jee Oakley, and Erika K. Cottrell are with the Oregon Community Health Information Network, Inc., Portland. Erika K. Cottrell is also with the School of Medicine, OHSU.
Am J Public Health. 2022 Jun;112(S5):S555-S562. doi: 10.2105/AJPH.2022.306913.
To describe patterns of providing moderately effective versus the most effective contraception and of providing implants versus intrauterine devices in US community health centers. We conducted a historical cohort study (2017-2019). Outcomes were woman-level receipt of most effective contraception (long-acting reversible contraception; implants and intrauterine devices) or moderately effective contraception. We used logistic regression to identify patient and clinic factors associated with providing (1) most versus moderately effective methods, and (2) implants versus intrauterine devices. We calculated adjusted probabilities for both outcomes by age group. We included 199 652 events of providing contraception to 114 280 women in 410 community health centers. Adjusted probabilities were similar across age groups for moderately versus most effective methods. However, the adjusted marginal means for receiving an implant compared with an intrauterine device were highest for adolescents (15-17 years: 78.2% [95% confidence interval (CI) = 75.6%, 80.6%]; 18-19 years: 69.5% [95% CI = 66.7%, 72.3%]). Women's health specialists were more likely to provide most versus moderately effective contraception. Community health centers are an important access point for most effective contraception for women of all ages. Adolescents are more likely to use implants than intrauterine devices. (. 2022;112(S5):S555-S562. https://doi.org/10.2105/AJPH.2022.306913).
描述美国社区卫生中心提供中等有效和最有效避孕措施以及提供植入物和宫内节育器的模式。我们进行了一项历史队列研究（2017-2019 年）。结果是女性获得最有效避孕措施（长效可逆避孕；植入物和宫内节育器）或中等有效避孕措施的情况。我们使用逻辑回归来确定与提供（1）最有效与中等有效方法以及（2）植入物与宫内节育器相关的患者和诊所因素。我们按年龄组计算了这两个结果的调整概率。我们纳入了 410 家社区卫生中心的 114280 名妇女的 199652 例避孕措施提供事件。在中等与最有效方法方面，调整后的概率在各个年龄组之间相似。然而，与宫内节育器相比，接受植入物的调整后的边缘均值在青少年中最高（15-17 岁：78.2%[95%置信区间（CI）=75.6%，80.6%]；18-19 岁：69.5%[95%CI=66.7%，72.3%]）。妇女健康专家更有可能提供最有效与中等有效避孕措施。社区卫生中心是所有年龄段女性获得最有效避孕措施的重要途径。青少年更有可能使用植入物而不是宫内节育器。（2022 年；112（S5）：S555-S562。https://doi.org/10.2105/AJPH.2022.306913）。
