Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial
Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial
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DOI：
10.1016/s0140-6736(14)62460-0
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发表时间：
2015-08-08
期刊：
影响因子：
168.9
通讯作者：
Speidel, J. Joseph
中科院分区：
文献类型：
--
作者：
Harper, Cynthia C.;Rocca, Corinne H.;Speidel, J. Joseph
在美国，意外怀孕仍然是一个严重的公共卫生挑战。我们评估了干预措施的影响，以增加患者获得长效可逆避孕药（LARC）对妊娠率的影响。方法我们在2011年至2013年在美国40个生殖健康诊所进行了一项随机分组试验。20个诊所被随机分配接受循证培训，提供咨询和插入宫内节育器（IUD）或子宫内膜异位素植入物，20个提供标准护理。所有研究中心均维持避孕费用。我们招募了年龄在18-25岁之间的女性，她们参加了计划生育或堕胎护理访问，并且在未来12个月内不希望怀孕。主要结局是在门诊访视时选择宫内节育器或植入物，次要结局是12个月内妊娠。我们使用聚类数据的广义估计方程来衡量干预对避孕选择的影响，并使用生存分析来评估妊娠率。结果在1500名妇女登记，更多的干预比对照网站报告接受咨询宫内节育器或植入物（565/797 [71%] vs 271/693 [39%]，比值比3.8，95% CI 2.8-5.2）和更多选择的LARC（224 [28%] vs 117 [17%]，1.9，1.3-2.8）。在计划生育访视后，干预组的妊娠率低于对照组（7.9 vs 15.4/100人-年），但在流产访视后则不然（26.5 vs 22.3/100人-年）。我们发现一个显着的干预效果，对怀孕率的妇女参加计划生育的访问（风险比0.54，95% CI 0.34-0.85）。解释怀孕率可以减少提供咨询，长期可逆避孕和访问设备在计划生育咨询访问。
Background Unintended pregnancy remains a serious public health challenge in the USA. We assessed the effects of an intervention to increase patients' access to long-acting reversible contraceptives (LARCs) on pregnancy rates.Methods We did a cluster randomised trial in 40 reproductive health clinics across the USA in 2011-13. 20 clinics were randomly assigned to receive evidence-based training on providing counselling and insertion of intrauterine devices (IUDs) or progestin implants and 20 to provide standard care. Usual costs for contraception were maintained at all sites. We recruited women aged 18-25 years attending family planning or abortion care visits and not desiring pregnancy in the next 12 months. The primary outcome was selection of an IUD or implant at the clinic visit and secondary outcome was pregnancy within 12 months. We used generalised estimating equations for clustered data to measure the intervention effect on contraceptive selection, and used survival analysis to assess pregnancy rates.Findings Of 1500 women enrolled, more at intervention than control sites reported receiving counselling on IUDs or implants (565 [71%] of 797 vs 271 [39%] of 693, odds ratio 3.8, 95% CI 2.8-5.2) and more selected LARCs during the clinic visit (224 [28%] vs 117 [17%], 1.9, 1.3-2.8). The pregnancy rate was lower in intervention group than in the control group after family planning visits (7.9 vs 15.4 per 100 person-years), but not after abortion visits (26.5 vs 22.3 per 100 person-years). We found a significant intervention effect on pregnancy rates in women attending family planning visits (hazard ratio 0.54, 95% CI 0.34-0.85).Interpretation The pregnancy rate can be reduced by provision of counselling on long-term reversible contraception and access to devices during family planning counselling visits.