Evaluation of an intervention designed to improve the management of difficult IUD insertions by advanced practice clinicians
Evaluation of an intervention designed to improve the management of difficult IUD insertions by advanced practice clinicians
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DOI：
10.1016/j.contraception.2016.01.011
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发表时间：
2016-06-01
期刊：
影响因子：
2.9
通讯作者：
Sanders, Jessica N.
中科院分区：
文献类型：
--
作者：
Dermish, Amna;Turok, David K.;Sanders, Jessica N.
目的：评估宫颈扩张和宫颈旁麻醉的临床技能培训，以及对困难插入的临床方案的引入，是否提高了高级临床医生（APCs）包括妇女健康和家庭执业护士、医师助理和注册护士助产士的宫内节育器插入成功率。研究设计：这项前瞻性研究评估了一项干预措施，以改善犹他州六家计划生育诊所apc的宫内节育器插入情况。我们收集了参与研究的临床医生在干预前（第1阶段）和干预后（第2阶段）两个观察阶段植入宫内节育器的数据。使用电子医疗记录，我们跟踪患者的特征，宫内节育器插入的成功，困难和失败。我们构建了一个混合效应的逻辑回归模型来控制提供者和患者的人口统计数据对插入成功率的影响。结果：9名临床医生参与了干预前和干预后阶段。分析包括428例宫内节育器置入手术（干预前242例，干预后186例）。在第1阶段，31/242（12.8%）插入失败。第2期的插入率提高了，只有8/186（4.3%）失败。使用混合效应逻辑回归，在控制提供者和患者特征的情况下，干预后插入成功的几率是干预前的4.8倍（aOR=4.8.95% CI 1.8-12.7）。插入失败的风险增加与1期无产和年龄较小相关，但与2期无关。结论：对apc进行简短的培训和使用临床方案来处理困难的插入可能能够提高宫内节育器的插入率。(C) 2016 Elsevier Inc.版权所有。
Objectives: To assess whether clinical skills training in cervical dilation and paracervical anesthesia, as well as the introduction of a clinical protocol for difficult insertions, increased intrauterine device (IUD) insertion success rates among advanced practice clinicians (APCs) including women's health and family practice nurse practitioners, physician assistants and certified nurse midwives.Study design: This prospective study assessed an intervention to improve IUD insertions among APCs at six family planning clinics in Utah. We collected data on IUD insertions performed by participating clinicians during two observation phases: preintervention (Phase 1) and postintervention (Phase 2). Using electronic medical records, we tracked patient characteristics, IUD insertion success, difficulties and failures. We constructed a mixed-effects logistic regression model to control for provider and patient demographics influencing insertion success rates.Results: Nine clinicians participated in both preintervention and postintervention phases. The analysis included 428 IUD insertion procedures (242 preintervention and 186 postintervention). During Phase 1, 31/242 (12.8%) insertions failed. Insertion rates in Phase 2 improved with only 8/186 (4.3%) failures. Using mixed-effects logistic regression, the odds of a successful insertion postintervention was 4.8 times greater than preintervention (aOR=4.8.95% CI 1.8-12.7) when controlling for provider and patient characteristics. Increased risk of insertion failure was associated with nulliparity and younger age during Phase 1, but not during Phase 2.Conclusions: A brief training for APCs and the use of a clinical protocol for difficult insertions may be able to improve IUD insertion rates. (C) 2016 Elsevier Inc. All rights reserved.