Challenges in translating evidence to practice - The provision of intrauterine contraception
Challenges in translating evidence to practice - The provision of intrauterine contraception
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DOI：
10.1097/aog.0b013e318173fd83
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发表时间：
2008-06-01
影响因子：
7.2
通讯作者：
Drey, Eleanor A.
中科院分区：
文献类型：
--
作者：
Harper, Cynthia C.;Blum, Maya;Drey, Eleanor A.
目的：宫内避孕在世界范围内被许多妇女使用，但在美国很少使用。尽管加州的低收入妇女可以从州计划生育项目免费获得宫内避孕药具，但每年只有1.3%的女性患者获得宫内避孕药具。本研究评估的知识和实践模式的从业人员关于宫内controlling.METHODS：我们进行了一项调查，医生，护士执业，和医生助理（n = 1,246）服务超过100名避孕患者，每年在加州国家计划生育计划。有效率为65%（N = 816）。我们采用多元Logistic回归来衡量不同的供应商types.Results之间的知识与临床practice的关联：百分之四十的供应商没有提供宫内避孕避孕的避孕患者，36%很少提供咨询，虽然92%的人认为他们的患者接受学习的方法。回归分析显示，年轻的医生和那些受过住院医师培训的医生更有可能提供插入。不到一半的临床医生认为未经产的妇女（46%）和流产后的妇女（39%）是合适的候选人。证据为基础的意见，可以安全地提供宫内避孕的患者类型与更多的咨询和方法提供，以及知识的出血模式的左炔诺孕酮释放宫内系统和铜device.CONCLUSION：处方的做法反映了错误的信念，宫内避孕药是适当的，只为一组有限的妇女。科学文献表明，宫内避孕药可以安全地用于许多妇女，包括流产后的患者。结果显示，需要对更新的插入指南和方法特定的副作用进行培训，包括激素和非激素器械之间的差异。
OBJECTIVE: Intrauterine contraception is used by many women worldwide, however, it is rarely used in the United States. Although available at no cost from the state family planning program for low-income women in California, only 1.3% of female patients obtain intrauterine contraceptives annually. This study assessed knowledge and practice patterns of practitioners regarding intrauterine contraception.METHODS: We conducted a survey among physicians, nurse practitioners, and physician assistants (n = 1,246) serving more than 100 contraceptive patients per year in the California State family planning program. The response rate was 65% (N = 816). We used multiple logistic regression to measure the association of knowledge with clinical practice among different provider types.RESULTS: Forty percent of providers did not offer intrauterine contraception to contraceptive patients, and 36% infrequently provided counseling, although 92% thought their patients were receptive to learning about the method. Regression analyses showed younger physicians and those trained in residency were more likely to offer insertions. Fewer than half of clinicians considered nulliparous women (46%) and postabortion women (39%) to be appropriate candidates. Evidence-based views of the types of patients who could be safely provided with intrauterine contraception were associated with more counseling and method provision, as well as with knowledge of bleeding patterns for the levonorgestrel-releasing intrauterine system and copper devices.CONCLUSION: Prescribing practices reflected the erroneous belief that intrauterine contraceptives are appropriate only for a restricted set of women. The scientific literature shows intrauterine contraceptives can be used safely by many women, including postabortion patients. Results revealed a need for training on updated insertion guidelines and method-specific side effects, including differences between hormonal and nonhormonal devices.