Health Care Provider Attitudes about the Safety of "Quick Start" Initiation of Long-Acting Reversible Contraception for Adolescents.

Autor: Morgan IA; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee., Zapata LB; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: lzapata@cdc.gov., Curtis KM; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia., Whiteman MK; Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Jazyk: angličtina
Zdroj: Journal of pediatric and adolescent gynecology [J Pediatr Adolesc Gynecol] 2019 Aug; Vol. 32 (4), pp. 402-408. Date of Electronic Publication: 2019 Feb 04.
DOI: 10.1016/j.jpag.2019.01.007
Abstrakt: Study Objective: To identify characteristics associated with provider attitudes on the safety of "Quick Start" initiation of long-acting reversible contraception (LARC) for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of providers in public-sector health centers and office-based physicians (n = 2056) during 2013-2014.
Results: Overall, the prevalence of considering "Quick Start" initiation of LARC for adolescents as safe was 70.9% for implants and 64.5% for intrauterine devices (IUDs). Among public-sector providers, those not trained in implant or IUD insertion had lower odds of perceiving the practice safe (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.25-0.41 for implants; aOR 0.42; 95% CI, 0.32-0.55 for IUDs), whereas those practicing at health centers that did not receive Title X funding had lower odds of perceiving the practice safe for IUDs (aOR, 0.77; 95% CI, 0.61-0.98). Among office-based physicians, lack of training in LARC insertion was associated with lower odds of perceiving "Quick Start" initiation to be safe for IUDs (aOR, 0.31; 95% CI, 0.12-0.77). Those specializing in adolescent medicine had higher odds of reporting "Quick Start" initiation of LARC as safe (implants: aOR, 2.21; 95% CI, 1.23-3.98; IUDs: aOR, 3.37; 95% CI, 1.39-8.21) compared with obstetrician-gynecologists.
Conclusion: Approximately two-thirds of providers considered "Quick Start" initiation of LARC for adolescents safe; however, there were differences according to provider characteristics (eg, Title X funding, training in LARC insertion, specialty). Targeted LARC insertion training and dissemination of evidence-based family planning guidance and implementation into facility and practice-level policies might increase access to "Quick Start" initiation of LARC for adolescents.
(Copyright © 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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