Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication
Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication
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DOI：
10.1177/0961203315596079
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发表时间：
2016-01-01
期刊：
影响因子：
2.6
通讯作者：
Katz, P.
中科院分区：
文献类型：
--
作者：
Ferguson, S.;Trupin, L.;Katz, P.
目的计划生育讨论是系统性红斑狼疮(SLE)妇女医疗保健的重要方面，因为活动性疾病是不良妊娠结局的危险因素，用于治疗的药物在妊娠期和妊娠期使用时可能对胎儿有害。我们的目的是考察患者对沟通质量和沟通类型的感知对接受避孕咨询的影响。方法数据来自加州大学旧金山分校狼疮结局研究的患者。个人参加每年一次的结构化电话采访，其中包括在开始服用新药时对避孕咨询的评估，以及沟通和决策的措施。用Logistic回归分析找出未接受避孕咨询的预测因素。结果在纳入分析的68名女性中，三分之一在开始服用新药时未接受避孕咨询。年龄较大、白人、抑郁症状和SLE疾病活动性较高独立地与未接受避孕咨询有关。没有接受避孕咨询的参与者在共享决策(SDM)沟通方面对医生的评价较低。结论这项研究表明，开始服用新药的SLE女性在计划生育咨询方面存在差距。为了提高对狼疮妇女的护理质量，需要进行未来的研究，以解决这些潜在的干预领域，包括关于更年期避孕必要性的教育，以及围绕避孕进行SDM的机制。
Objective Family planning discussions are an important aspect of medical care for women with systemic lupus erythematosus (SLE) as active disease is a risk factor for poor pregnancy outcomes, and the medications used for treatment can be harmful to the fetus when used during conception and pregnancy. Our objective was to examine the impact of patient perception of quality and type of communication on receiving contraception counseling.Methods Data were derived from patients enrolled in the University of California, San Francisco Lupus Outcomes Study. Individuals participate in a yearly structured telephone interview that includes assessment of contraception counseling when starting new medications, and measures of communication and decision making. Logistic regression was performed to identify predictors of not receiving contraception counseling.Results Of the 68 women included in this analysis, one-third did not receive contraception counseling when starting new medications. Older age, white race, depressive symptoms, and higher SLE disease activity were independently associated with not receiving contraception counseling. Participants who did not receive contraception counseling rated their physicians lower in shared decision-making (SDM) communication.Conclusions This study demonstrates a gap in family planning counseling among women with SLE starting new medications. Future studies to address these potential areas of intervention, including education about the need for contraception through menopause, and mechanisms to engage in SDM surrounding contraception are needed to improve quality of care for women with lupus.