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

项目摘要/摘要 预防性盆腔检查，或对无症状的非怀孕妇女进行的检查，一直是一种 几十年来一直是预防性妇科护理的标准组成部分。今天，更严格，更少侵入性 筛查机制在有效检测疾病方面已经超过了预防性盆腔检查 比如性传播感染和宫颈癌，这些疾病以前都要进行预防性盆腔检查 使用。此外，预防性盆腔检查经常使年轻女性感到恐惧或尴尬。 并有助于不必要的、有害的和资源密集型的后续诊断程序。根据…… 最近的审查和立场声明对广泛或常规使用预防性骨盆提出了质疑 考试。更重要的是，预防性盆腔检查一直是自我保护的不必要障碍。 使用荷尔蒙避孕方法。预防性盆腔检查是自我给药的先决条件 荷尔蒙避孕药的使用已从药品标签和实践建议中删除，因为 这些检查并不是安全、有效地使用这些避孕药所必需的。然而，针对这些 要求和建议，大多数医生仍然要求在进行预防性盆腔检查之前 开出口服避孕药。这一拟议项目的总体目标是评估 实施预防性盆腔检查，并将其作为自我检查的先决条件 使用激素避孕，这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进 医疗保健质量和患者结局。在目标1中，我们将使用一个医疗和处方数据库 雇主赞助的商业保险妇女的索赔数据，以检查 首次建议使用常规方法的社会指南改变后的预防性盆腔检查 2014年，美国医师学会进行了预防性骨盆检查。在目标2中，我们将使用调查来 了解女性对盆腔检查作为避孕措施使用障碍的经验和看法。在……里面 目标3，我们将使用与目标1相同的数据库来评估为自己开处方的女性是否 使用荷尔蒙避孕方法(避孕药、贴片或避孕环)体验更高 在最近的一次预防性护理访问中，预防性盆腔检查的患病率与未使用的妇女相比 那些方法。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 以及与预防性盆腔检查和自我保健相关的循证妇科护理的患者 实施荷尔蒙避孕。

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.