Enhancing Referral of Sexually Active Adolescent Females from the Emergency Department to Family Planning
Enhancing Referral of Sexually Active Adolescent Females from the Emergency Department to Family Planning
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DOI：
10.1089/jwh.2014.4994
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发表时间：
2015-04-01
影响因子：
3.5
通讯作者：
Dayan, Peter S.
中科院分区：
文献类型：
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作者：
Chernick, Lauren S.;Westhoff, Carolyn;Dayan, Peter S.
背景：怀孕风险较高的女性青少年经常去急诊室 (ED)，但缺乏主要医疗服务提供者。目前尚不清楚目前的急诊转诊方法是否成功。这项试点研究的目的是评估标准化、强化的方法的潜在效果和可行性，该方法将性活跃的女性从急诊科转诊至计划生育 (FP)。 方法：我们使用强化转诊流程进行了一项基于急诊科的干预研究，其中包括一张钱包卡，宣传对青少年友好的 FP 诊所和标准化的急诊科医生独白。急诊科医生被指示向 12-19 岁性活跃的女性（干预组）传播强化流程。接受干预的患者被前瞻性地纳入。对照组由回顾性审查时在入组期间来到急诊科且符合资格但未入组的患者组成。我们利用电子病历（EMR）来识别并随机选择漏诊的符合条件的患者（对照组），并为每个病例积累一个对照。主要结局是 2 个月内的 FP 随访，通过 EMR 审核进行测量。结果：干预组 (n=101) 和对照组 (n=101) 在年龄、既往急诊就诊（54% 对 56%）和既往 FP 就诊（28% 对 28%）方面相似。强化转诊组 (7%; 7/101) 与非强化转诊组 (5%; 5/101) 之间 FP 诊所随访的绝对差异仅为 2%（95% 置信区间 -5% 至 9%）。干预的可行性不大，最好的情况是捕获 59/160 (37%) 的符合条件的患者。结论：依赖于医生参与的强化转诊举措并没有大幅提高 FP 诊所的随访率，并且显示出适度的可行性。需要更多的研究来确定基于急诊室的预防性生殖护理转诊的有效方法。
Background: Female adolescents at high pregnancy risk frequently visit the emergency department (ED) and lack primary providers. It is unclear if current methods of ED referral are successful. The objective of this pilot study was to assess the potential effect and feasibility of a standardized, enhanced method of referral of sexually active females from an ED for family planning (FP).Methods: We conducted an ED-based intervention study using an enhanced referral process, which included a wallet card advertising a walk-in, adolescent-friendly FP clinic and a standardized ED physician monologue. ED physicians were instructed to disseminate the enhanced process to sexually active females ages 12-19 years (intervention group). Patients receiving the intervention were prospectively enrolled. The control group consisted of patients who, on retrospective review, came to the ED during the enrollment period and were eligible but were not enrolled. We used the electronic medical record (EMR) to identify and randomly select missed eligible patients (control group) and accumulated one control for each case. The primary outcome was FP follow-up within 2 months, measured by EMR review.Results: The intervention (n=101) and control groups (n=101) were similar in age, prior ED visits (54% versus 56%), and previous FP visits (28% versus 28%). The absolute difference in follow-up to a FP clinic between the enhanced referral group (7%; 7/101) compared with the nonenhanced referral group (5%; 5/101) was only 2% (95% confidence interval -5% to 9%). Feasibility of the intervention was modest, with a best-case scenario of 59/160 (37%) of eligible patients captured.Conclusions: An enhanced referral initiative relying on physician participation did not substantially increase follow-up rates to a FP clinic and showed modest feasibility. More research is required to identify effective means of ED-based referral for preventive reproductive care.