Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing.
Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing.
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DOI：
10.1097/aog.0000000000004505
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发表时间：
2021-09-01
影响因子：
7.2
通讯作者：
Mitra M
中科院分区：
文献类型：
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作者：
Wu JP;Zhang J;McKee M;Akobirshoev I;McKee KS;Mitra M
评估失聪或听力障碍人群的避孕措施和避孕护理质量措施，并将这些结果与非失聪或听力障碍人群进行比较。我们对2014年马萨诸塞州全付款人索赔数据库的数据进行了索赔分析。在15-44岁的绝经前受试者中，我们确定了是否提供任何避孕措施（是/否）和按避孕方式提供的避孕措施：处方避孕措施（药片、贴片、环、注射剂或隔膜）、长效可逆避孕（LARC）装置和永久性避孕措施（输卵管绝育）。我们将这些结果与耳聋或听力障碍状态（是/否）进行比较。使用回归模型计算避孕措施提供的几率，调整了年龄、医疗补助收据、预防性健康访问以及耳聋或听力障碍状况。根据美国人口健康办公室的数据，我们计算了避孕护理质量指标，即使用LARC方法的参保者的百分比：或2)最有效或中等有效的方法（输卵管绝育、药片、贴片、环、注射剂或隔膜）。我们确定了1171838名有妊娠风险的入组者；耳聋、重听13400人（1.1%）。在失聪或重听人群中，31.4%的人采取了避孕措施（处方避孕23.5%,LARC 5.4%，输卵管绝育0.7%）。失聪或听力障碍患者接受处方避孕的可能性低于非失聪或听力障碍患者（aOR 0.92, 95% CI 0.88-0.96）。接受最有效或中等有效方法的失聪或重听个体的百分比低于未接受最有效或中等有效方法的个体（24.2%比26.3%,p<0.001）。聋人和听力障碍患者在提供LARC或永久性避孕方面没有差异。失聪或听力障碍的个体接受处方避孕的可能性低于非失聪个体；这种模式背后的因素需要加以研究。提供LARC或永久避孕没有因失聪或听力障碍而有所不同。应监测这些发现，并将其与对避孕药具覆盖率有不同要求的各州的数据进行比较。耳聋或听力困难的人不太可能获得处方避孕药（药片、贴片、避孕环、避孕针、避孕膜）。
To evaluate contraceptive provision and contraceptive care quality measures for individuals who are deaf or hard of hearing and compare these outcomes to those individuals who are not. We conducted a claims analysis with data from the 2014 Massachusetts All-Payer Claims Database. Among premenopausal enrollees aged 15-44, we determined provision of any contraception (yes/no) and provision by contraception type: prescription contraception (pills, patch, ring, injectables, or diaphragm), long-acting reversible contraceptive (LARC) devices, and permanent contraception (tubal sterilization). We compared these outcomes by deaf or hard-of-hearing status (yes/no). The odds of contraceptive provision were calculated with regression models adjusted for age, Medicaid receipt, a preventive health visit, and deaf or hard-of-hearing status. We calculated contraceptive care quality measures, per the U.S. Office of Population Health, as the percentage of enrollees who used: 1) LARC methods; or 2) most effective or moderately effective methods (tubal sterilization, pills, patch, ring, injectables, or diaphragm). We identified 1,171,838 enrollees at risk for pregnancy; 13,400 (1.1%) were deaf and hard of hearing. Among individuals who were deaf or hard of hearing, 31.4% were provided contraception (23.5% prescription contraception, 5.4% LARC, 0.7% tubal sterilization). Individuals who were deaf or hard of hearing were less likely to receive prescription contraception (aOR 0.92, 95% CI 0.88-0.96) than individuals who were not. The percentage of individuals who were deaf or hard of hearing who received most effective or moderately effective methods was less than that for individuals who were not (24.2% vs. 26.3%, p<0.001). There were no differences in provision of LARC or permanent contraception by deaf and hard-of-hearing status. Individuals who were deaf or hard of hearing were less likely to receive prescription contraception than individuals who were not; factors underlying this pattern need to be examined. Provision of LARC or permanent contraception did not differ by deaf or hard-of-hearing status. These findings should be monitored and compared with data from states with different requirements for contraceptive coverage. Individuals who are deaf or hard of hearing are less likely to be provided prescription contraceptives (pill, patch, ring, shot, diaphragm).