Bimanual Pelvic Examinations: Temporal Patterns and Imposed Barriers to Contraception Use

项目摘要/总结 预防性盆腔检查，或对无症状的非妊娠妇女进行的检查， 几十年来预防性妇科护理的标准组成部分。今天，更严格和更少的侵入性 筛查机制在有效发现疾病方面已超过预防性盆腔检查 例如性传播感染和宫颈癌，预防性盆腔检查以前 采用此外，预防性盆腔检查经常引起年轻妇女的恐惧或尴尬 并导致不必要的、有害的和资源密集型的后续诊断过程。鉴于 因此，最近的评论和立场声明质疑预防性盆腔炎的广泛或常规使用， 考试更重要的是，预防性盆腔检查已经成为自我检查的不必要的障碍， 使用激素避孕药。预防性盆腔检查作为自我管理的先决条件 激素避孕药使用已从药物标签和实践建议中删除， 这些检查对于安全、有效地使用这些避孕药具并不是必需的。然而，针对这些 要求和建议，大多数医生仍然需要一个预防性盆腔检查，然后才 开口服避孕药。该项目的总体目标是评估... 定期进行预防性盆腔检查，并将其作为自我检查的先决条件， 使用激素避孕药是一种无效和有害的临床做法。这 目标与AHRQ研究优先领域保持一致，以利用数据和技术来改善 医疗保健质量和患者结果。在目标1中，我们将使用医疗和处方数据库 雇主赞助的商业保险妇女的索赔数据， 第一个社会指南变更后的预防性盆腔检查，建议使用常规 2014年，美国内科医师学会（American College of Physicians）的预防性盆腔检查。在目标2中，我们将使用调查来 了解妇女对盆腔检查的经历和看法，将其视为避孕措施使用的障碍。在 目标3，我们将使用与目标1相同的数据库来评估女性是否为自我治疗而开具处方， 服用激素避孕方法（避孕药，贴片或戒指）的经验更高 与未使用预防性盆腔检查的女性相比， 这些方法。我们的工作将提供证据，为支持和授权提供者的干预措施提供信息 和患者进行与预防性盆腔检查相关的循证妇科护理， 使用激素避孕。

PROJECT ABSTRACT/SUMMARY Preventive pelvic examinations, or those performed in asymptomatic, non-pregnant women, have been a standard component of preventive gynecologic care for decades. Today, more rigorous and less invasive screening mechanisms have surpassed the preventive pelvic examinations in effectively detecting diseases such as sexually transmitted infections and cervical cancer, for which preventive pelvic exams were previously used. Furthermore, preventive pelvic examinations frequently induce fear or embarrassment in young women and contribute to unnecessary, harmful, and resource-intensive subsequent diagnostic procedures. In light of this, recent reviews and position statements question the widespread or routine use of preventive pelvic examinations. More importantly, preventive pelvic exams have been an unnecessary barrier to self- administered hormonal contraception access. Preventive pelvic exams as a prerequisite to self-administered hormonal contraception use have been removed from drug labeling and practice recommendations because these exams are not necessary to facility safe, effective use of these contraceptives. However, against these requirements and recommendations, most physicians still require a preventive pelvic examination before they prescribe oral contraceptives. The overall goals of this proposed project are to evaluate the de- implementation of the use of preventive pelvic exams routinely and as a prerequisite to self- administered hormonal contraception access, a clinical practice that is ineffective and harmful. This objective aligns with the AHRQ Research Priority Area to harness data and technology to improve health care quality and patient outcomes. In Aim 1, we will use a database of medical and prescription claims data of employer-sponsored commercially insured women to examine the changes in rates of preventive pelvic exams following the first societal guideline changes recommending the use of routine preventive pelvic exams, from the American College of Physicians in 2014. In Aim 2, we will use a survey to understand women’s experiences with and perceptions of pelvic exams as a barrier to contraception use. In Aim 3, we will use the same database from Aim 1 to evaluate whether women who fill a prescription for a self- administered hormonal contraceptive method (contraceptive pills, patch, or ring) experience a higher prevalence of preventive pelvic exams at a recent preventive care visit compared to women who are not using those methods. Our work will provide evidence to inform interventions that will support and empower providers and patients for evidence-based gynecologic care related to preventive pelvic exams and access to self- administered hormonal contraception.