Improving contraceptive decision support for individuals with chronic conditions

项目摘要 既往患有慢性病的女性更有可能经历意外怀孕和 妊娠并发症比没有慢性病的同龄人要好。因为不使用避孕药(不是 使用任何避孕方法)会造成计划外怀孕的最大风险，而且更普遍 在慢性病患者中，迫切需要支持这一群体的避孕目标。 避孕决策是避孕使用的关键前提，也是一个高度个人化的过程。一个 显著的临床护理缺口是缺乏资源来满足独特的避孕决策需求 患有慢性病的患者，例如了解哪些方法可以改善或恶化他们的 症状(如贫血)或疾病自我管理(如体重)。患者还应该知道他们的慢性 条件对特定方法构成健康禁忌症，如果是，还可以使用哪些其他方法 安全无恙。然而，临床医生，包括初级保健提供者，通常不会引起患者的偏好或 应用循证避孕指南为患有慢性病的患者提供咨询。要解决这些问题 ，我们设计了一个基于网络的工具，我的健康我的选择(MHMC)，以教育慢性病患者 关于他们的避孕选择的情况，并促进临床医生遵守 疾病预防控制中心(CDC)。MHMC是创新的，因为它是第一个理论-- 知情的、用户测试的避孕决策支持工具，面向慢性病患者和 他们的临床医生。我们的长期目标是通过避孕干预改善生殖健康。 一般护理设置。在我们有希望的试点数据的基础上，研究目标是评估 使用混合方法比较MHMC(干预)的双臂平行整群随机试验中的MHMC 在14家提供避孕措施的初级保健诊所提供常规避孕服务(对照)。我们假设 MHMC的使用将改善患者报告的避孕决策质量和避孕质量 来自临床医生的咨询，这将导致避孕用具的增加和避孕用具的减少 不用了。本研究的目的是：目标1(主要)：评价MHMC对避孕药未使用的影响。目标 2(次级)：评估MHMC对遵守美国疾病控制与预防中心避孕指南的影响 混合方法。目标3：(探索性)：定量探讨决策质量和避孕措施 咨询作为MHMC对初级和次级措施影响的中介。预期中的 结果是关于一种新的避孕决策工具对患有疾病的人的有效性的新发现 慢性疾病。该项目将推动可扩展的、以人为中心的避孕药的发展 对现实世界临床环境中的医学高危患者的干预。

PROJECT ABSTRACT Women with pre-existing chronic conditions are more likely to experience unplanned pregnancy and pregnancy complications than their peers without chronic conditions. Because contraceptive nonuse (not using any contraceptive method) poses the greatest risk of unplanned pregnancy and is more prevalent among those with chronic conditions, there is an urgent need to support the contraceptive goals of this group. Contraceptive decision-making is a critical antecedent to contraceptive use, and a highly personal process. A significant clinical care gap is the lack of resources that address the unique contraceptive decision needs of patients with chronic conditions, such as understanding which methods may improve or worsen their symptoms (e.g., anemia) or disease self-management (e.g., weight). Patients should also know if their chronic conditions pose a health contraindication to a specific method, and if so, which other methods can be used safely. However, clinicians, including primary care providers, do not routinely elicit patient preferences or apply evidence-based contraceptive guidelines to counsel patients with chronic conditions. To address these gaps, we designed a web-based tool, My Health My Choice (MHMC), to educate patients with chronic conditions about their contraceptive options and promote clinician adherence to contraceptive guidelines from the Centers for Disease Control and Prevention (CDC). MHMC is innovative because it is the first theory- informed, user-tested contraceptive decision support tool that targets both patients with chronic conditions and their clinicians. Our long-term goal is to improve reproductive health through contraceptive interventions in general care settings. Building upon our promising pilot data, the study objective is to evaluate the efficacy of MHMC in a two-arm, parallel cluster-randomized trial using mixed methods to compare MHMC (intervention) to usual contraceptive care (control) in 14 primary care clinics that provide contraception. We hypothesize that MHMC use will improve patient-reported quality of contraceptive decision-making and quality of contraceptive counseling from their clinicians, which will lead to increased contraceptive use and decreased contraceptive nonuse. The study aims are: Aim 1(Primary): To evaluate the impact of MHMC on contraceptive nonuse. Aim 2 (Secondary): To assess the impact of MHMC on adherence to the CDC Contraceptive Guidelines using mixed methods. Aim 3: (Exploratory): To quantitatively explore decisional quality and contraceptive counseling as mediators of the effects of MHMC on primary and secondary measures. The expected outcomes are new findings regarding the efficacy of a novel contraceptive decision tool for individuals with chronic conditions. This project will inform the development of scalable, person-centered contraceptive interventions for medically at-risk patients in real-world clinical settings.