Multi-level Emergency Department Intervention to Reduce Pregnancy Risk Among Adolescents

项目总结 美国青少年意外怀孕的负担很大，尽管怀孕率有所下降 在最近几年。尽管存在高效的避孕方法，但青少年面临着多层次的障碍 获得和使用避孕药具。研究重点是增加青少年的避孕启动率 至关重要。急诊科(ED)是一种非传统的设置，可以很好地提供 生殖保健，由于每年有近1900万青少年在急诊室寻求护理，许多人愿意 在这种情况下接受护理，而急诊科通常是与卫生保健系统的唯一或主要接触者 风险最高的年轻人。我们提出了一种新的避孕咨询干预措施，用于设置该地址的ED 患者、提供者和系统层面的障碍。在前人工作的基础上，借鉴成熟的经验 策略从传统环境中，我们将培训ED高级实践护士，以提供咨询利用 动机访谈策略，以促进接受以ED为基础的避孕或临床转诊 15-18岁的性行为活跃的女性。我们将进行一项小型随机试验来评估这些可行性。 使用混合方法的构建：可接受性、需求、实现、实用性、适应性、 整合、扩展和效果有限。我们比较两个手臂(干预与增强的标准 CARE)，以确定避孕开始有效率的大小。我们收集数据为未来的研究提供参考 评估单个组件并确定最简约的有源组件组合 一种适应性设计。我们希望这些数据能为试验提供足够的样本，以评估在 避孕药具亚型，并找出加强或抑制避孕药具使用的特征。这个项目是 重要的是因为全国青少年生育的负担(仅一年就有94亿美元)是如此之大， 即使发病率略有下降，也应该会显著降低成本，并缩短 贫穷和健康状况不佳。

PROJECT SUMMARY The burden of adolescent unintended pregnancy in the US is substantial, despite declines in pregnancy rates in recent years. Although highly effective contraceptive methods exist, adolescents face multi-level barriers to contraceptive access and use. Research focused on increasing contraception initiation among adolescents is crucial. The emergency department (ED) is a non-traditional setting that is well-positioned to provide reproductive care, as almost 19 million adolescents seek care in EDs each year, many are amenable to receiving care in this setting, and the ED is often the only or primary contact with the health care system for the highest-risk youth. We propose a novel contraceptive counseling intervention for the ED setting that address barriers at the patient, provider, and system levels. Building on previous work and drawing on proven strategies from traditional settings, we will train ED advanced practice nurses to provide counseling utilizing Motivational Interviewing strategies to facilitate uptake of ED-based contraception or clinic referral among sexually active females aged 15-18 years. We will conduct a small randomized trial to evaluate these feasibility constructs using mixed methodology: acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited-efficacy. We compare two arms (intervention vs. enhanced standard of care) to determine size of effect rates on contraception initiation. We gather data to inform a future study to evaluate individual components and identify the most parsimonious combination of active components using an adaptive design. We expect these data to inform a trial with adequate sample to evaluate efficacy among contraceptive subtypes and to identify characteristics that enhance or inhibit contraception use. This project is significant because the national burden of adolescent childbearing ($9.4 billion for one year alone) is so great, even a small reduction in incidence should lead to significant cost reductions and reduce generational cycles of poverty and poor health outcomes.