Cromer B A, Berg-Kelly K S, Van Groningen J P, Seimer B S, Ruusuvaara L
Department of Pediatrics, Ohio State University College of Medicine, Columbus Children's Hospital, 43205, USA.
J Adolesc Health. 1998 Aug;23(2):74-80. doi: 10.1016/s1054-139x(98)00030-5.
To compare attitudes and practices related to clinicians' use of depot medroxyprogesterone acetate [Depo-Provera (DMPA)] and levonorgestrel implants in adolescents in three northern European countries and the United States.
Between the fall of 1993 and the winter of 1995, surveys eliciting clinician attitudes and practices with the two contraceptive methods were collected from practitioners who provide contraceptive care to teens in Sweden (n = 282), The Netherlands (n = 197), Great Britain (n = 108), and the United States (n = 548).
Clinicians in Great Britain and the United States reported prescribing of DMPA, selected DMPA in their top three choices for contraception in teens, and had patients ask about DMPA more frequently than clinicians in Sweden or The Netherlands (p < 0.0001). U.S. clinicians were more likely to report prescribing of the implants, list them as a top choice, and have patients ask for it more frequently than were providers in the other three countries (p < 0.0001). Noncompliance with previous contraceptives was the most common indication for use of either method in this age group. "Worst fears" with DMPA use included infertility, particularly among Swedish clinicians (p < 0.0001), as was pregnancy and loss to follow-up, particularly among British clinicians (p < 0.0001). Condom nonuse was a concern associated with both methods. Breakthrough uterine bleeding was a concern related to implant use, particularly among Swedish practitioners (p < 0.0001).
Clinicians in the United States and Great Britain display more enthusiasm toward the use of the long-term progestins in adolescents than do clinicians in Sweden or The Netherlands. Continuing education programs could be designed to educate clinicians to allay their concerns about these contraceptives in countries where teen pregnancy is considered a problem.
比较北欧三个国家和美国临床医生在青少年中使用醋酸甲羟孕酮长效注射剂[狄波 - 普维拉（DMPA）]和左炔诺孕酮宫内节育系统的态度和做法。
在1993年秋季至1995年冬季期间，从瑞典（n = 282）、荷兰（n = 197）、英国（n = 108）和美国（n = 548）为青少年提供避孕护理的从业者那里收集了有关临床医生对这两种避孕方法的态度和做法的调查。
英国和美国的临床医生报告了DMPA的处方情况，将DMPA列为青少年避孕的前三大选择，并且他们的患者询问DMPA的频率高于瑞典或荷兰的临床医生（p < 0.0001）。与其他三个国家的提供者相比，美国临床医生更有可能报告宫内节育系统的处方情况，将其列为首选，并且患者询问的频率更高（p < 0.0001）。在这个年龄组中，对先前避孕方法的不依从是使用这两种方法最常见的指征。使用DMPA的“最大担忧”包括不孕，瑞典临床医生尤其如此（p < 0.0001），还有怀孕和失访，英国临床医生尤其如此（p < 0.0001）。不使用避孕套是与这两种方法都相关的一个问题。突破性子宫出血是与宫内节育系统使用相关的一个问题，瑞典从业者尤其如此（p < 0.0001）。
与瑞典或荷兰的临床医生相比，美国和英国的临床医生对在青少年中使用长效孕激素表现出更高的热情。可以设计继续教育项目，以教育临床医生减轻他们在青少年怀孕被视为问题的国家中对这些避孕方法的担忧。
