Contraception最新文献_第2页

BELIEFS ABOUT TRUSTING WOMEN TO MAKE THEIR OWN ABORTION DECISIONS AND PUNISHMENT FOR SELF-MANAGED MEDICATION ABORTION IN A NATIONALLY REPRESENTATIVE SAMPLE 在全国代表性样本中，关于信任妇女自行做出堕胎决定的信念以及对自我管理的药物流产的惩罚情况

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110613

A Becker, R Schroeder, L Ralph, S Kaller, MA Biggs

Objectives

Given the anticipated increase in self-managed medication abortion due to decreased access to facility-based abortion in the US after Dobbs v Jackson Women’s Health Organization, we examined lay attitudes regarding trusting pregnant people to make their own abortion decisions and whether trusting women is associated with beliefs about punishment for self-managed medication abortion.

Methods

We conducted a nationally representative cross-sectional survey of 7,148 people assigned female at birth (AFAB), aged 15–49 from May to July 2023, using a probability-based panel. Participants were asked to indicate whether they agree or disagree that “Most women are capable of making the best decision on abortion for themselves.” We calculated a mean Trust women score (1–5, 5=higher trust). We conducted multivariable regression to assess factors associated with trusting women and whether trusting women was associated with support for reporting people to Child Protective Services or the police, having them pay a fine, or jailing those who self-managed a medication abortion.

Results

The mean Trust Women score was 2.6 (SD= 1.24). Respondents were evenly split between trusting women (50.36% agreed/strongly agreed, 49.64% disagreed, strongly disagreed, or neither agreed nor disagreed). Identifying as a gender or sexual minority, as Democrat, as non-Hispanic Black, and supportive of legal access to in-clinic abortion were associated with higher odds in trusting women to make abortion decisions. Trusting women was associated with decreased support for all forms of punishment for self-managed medication abortion.

Conclusions

Beliefs about trusting women are polarized, with only half of AFAB people reporting trusting women to make their own abortion decisions; these attitudes are associated with beliefs about punishing those who self-manage a medication abortion.

目标鉴于美国在多布斯诉杰克逊妇女健康组织案之后，由于设施内堕胎的机会减少，自我管理的药物流产预计会增加，我们研究了非专业人士对于信任孕妇自己做出堕胎决定的态度，以及信任女性是否与自我管理药物流产的惩罚信念相关。调查要求参与者回答是否同意 "大多数女性有能力为自己做出堕胎的最佳决定"。我们计算了 "信任女性 "的平均得分（1-5，5=信任度更高）。我们进行了多变量回归，以评估与信任女性相关的因素，以及信任女性是否与支持向儿童保护服务机构或警方举报、让她们支付罚款或监禁自行管理药物流产者相关。受访者对女性的信任度各占一半（50.36% 表示同意/非常同意，49.64% 表示不同意、非常不同意或既不同意也不不同意）。性别或性少数群体、民主党人、非西班牙裔黑人以及支持合法获得诊所内堕胎服务的受访者信任女性做出堕胎决定的几率较高。信任妇女与减少对自行管理药物流产的各种形式惩罚的支持有关。结论信任妇女的信念是两极分化的，只有一半的非洲裔美国人报告说信任妇女能做出自己的流产决定；这些态度与惩罚自行管理药物流产者的信念有关。

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引用次数: 0

POSITIONALITY AND PRIVILEGE POST-DOBBS: A QUALITATIVE ANALYSIS OF OB-GYN GRADUATES’ DECISION-MAKING 后多布斯时代的地位和特权：对妇产科毕业生决策的定性分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110618

AL Woodcock, M Asadian, E Torres, J Kaiser, J Baayd

Objectives

We aimed to understand the impact of the Dobbs v Jackson Women’s Health Organization decision on recent obstetrician gynecologist (Ob-Gyn) graduates with an emphasis on career decisions.

Methods

We performed 30 semi-structured interviews of residents who graduated from residencies with Ryan Abortion training Programs in July 2023. Interviewees were invited from a list of those who had previously completed a national survey. Interview questions addressed the professional and personal impact of the Dobbs decision as well as its impact on decision-making for fellowship ranking or attending positions. We analyzed interview transcripts using the Template Analysis Method.

Results

Our template analysis resulted in the overarching theme of positionality and privilege. Participants experienced abortion restrictions distinctly in relation to opposing positionalities: being physically located in restrictive vs non-restrictive states, being an abortion vs non-abortion provider, being a healthcare provider vs a patient, and identifying as female vs male. Those of less impacted positionalities commonly cited feeling “privileged,” “fortunate,” or “lucky” when describing the lack of impact of Dobbs on their lives, both personally and professionally. When asked what they desire from lawmakers, the theme of positionality and privilege persisted. Respondents want lawmakers to check their privilege and empathize with the patients who seek abortion care by shadowing clinicians in the office or listening to their stories.

Conclusions

Recently graduated Ob-Gyns are navigating through different decision-making realities post-Dobbs. Sharing the experiences of these opposing positionalities can be used to inform shared action and advocacy nationally in abortion care.

方法我们对 2023 年 7 月从瑞安流产培训项目住院医师培训机构毕业的住院医师进行了 30 次半结构式访谈。受访者是从之前完成全国性调查的受访者名单中邀请的。访谈问题涉及多布斯决定对专业和个人的影响，以及对奖学金排名或主治医生职位决策的影响。我们采用模板分析法对访谈记录进行了分析。结果我们的模板分析得出了 "地位和特权 "这一总主题。参与者对堕胎限制的体验与对立的立场有关：身处限制州与非限制州、作为堕胎提供者与非堕胎提供者、作为医疗保健提供者与患者，以及女性身份与男性身份。那些受影响较小的人在描述多布斯对他们的个人和职业生活没有影响时，通常会说自己感到 "荣幸"、"幸运 "或 "幸运"。当被问及他们希望立法者做些什么时，地位和特权的主题依然存在。受访者希望立法者能够检查他们的特权，并通过在诊室里跟随临床医生或倾听他们的故事来同情寻求堕胎护理的患者。分享这些对立立场的经验可用于在全国范围内开展堕胎护理方面的共同行动和宣传。

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引用次数: 0

Featured research at the 2024 Society of Family Planning Annual Meeting 2024 年计划生育协会年会上的特色研究。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110679

Rana E. Barar (MPH; Society of Family Planning at large Board member), Anitra Beasley (MD, MPH; Society of Family Planning Board President-Elect), Nerys Benfield (MD, MPH; Society of Family Planning at large Board member), Catherine Cansino (MD, MPH; Society of Family Planning at large Board member and Co-chair of the Diversity, Equity, and Inclusion Advisory Group), Blair G. Darney (PhD, MPH; Society of Family Planning at large Board member), Sadia Haider (MD, MPH; Society of Family Planning Board President and Chair of scientific abstract selection), Kate Shaw (MD, MS; Society of Family Planning Board Secretary)

引用次数: 0

LEVONORGESTREL 52 MG INTRAUTERINE DEVICE PLACEMENT WITHOUT SOUNDING: A FEASIBILITY STUDY 左炔诺孕酮 52 毫克宫内节育器的无声放置：可行性研究

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110581

J Brown, S Yazdani, N Economou, A Flynn, H Rankin, MD Creinin

Objectives

We aimed to evaluate feasibility of levonorgestrel 52 mg intrauterine device (IUD) placement without sounding.

Methods

In this three-phase feasibility study, participants in phase one had uterine sounding prior to IUD placement. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography. We timed procedure length from the sound (phase one) or IUD inserter (phases two/three) touching the cervix to full inserter removal. Providers used cervical anesthesia per their discretion. Participants rated pain using a 100 mm Visual Analogue Scale. Physicians described procedures as easy, moderate, or difficult. Participants in phases two and three had three-month follow-up with ultrasonography. We estimated 30 participants per phase were needed to ensure that if one failed placement occurred, the lower 95% confidence interval for successful placement would be ≥90%.

Results

We enrolled 30 participants per phase. Successful placement without sounding occurred in 30 (100%) participants in phase two and 28 (93.3%) in phase three. Median instrumentation was shorter without sounding (79.7 vs 23.3 vs 42.4 seconds; p=0.04). Median pain was lowest in phase one (21.0 vs 25.5, vs 36.0; p=0.04). Physicians rated IUD placement easy most often in phase two (n=29, 96.7%) compared to phases one (n=22, 73.3%) or three (n=22, 73.3%; p=0.03). Complications included one perforation and one expulsion in phase three.

Conclusions

IUD placement without sounding is feasible with concurrent transabdominal sonography. Placement without sounding results in shorter instrumentation time but does not decrease pain. Large studies are indicated to evaluate complication rates when no sound and no ultrasonography is used.

方法在这项分三个阶段进行的可行性研究中，第一阶段的参与者在放置宫内节育器前进行了子宫探查。在实验阶段，放置宫内节育器时不进行探查，同时进行（第二阶段）或不进行（第三阶段）经腹超声检查。我们对从宫颈探音（第一阶段）或宫内节育器置入器（第二/三阶段）接触宫颈到完全取出置入器的过程进行了计时。医生酌情使用宫颈麻醉。参与者使用 100 毫米视觉模拟量表对疼痛进行评分。医生将手术分为简单、中等和困难三个等级。第二和第三阶段的参与者接受了为期三个月的超声波随访。我们估计每个阶段需要 30 名参与者，以确保即使出现一次置管失败，成功置管的 95% 置信区间下限也将≥90%。第二阶段有 30 人（100%）成功置管，第三阶段有 28 人（93.3%）成功置管。中位器械置入时间更短（79.7 秒 vs 23.3 秒 vs 42.4 秒；P=0.04），无探头。第一阶段的疼痛中位数最低（21.0 vs 25.5，vs 36.0；P=0.04）。与第一阶段（22 人，73.3%）或第三阶段（22 人，73.3%；P=0.03）相比，第二阶段（29 人，96.7%）医生最常将宫内节育器放置简单化。并发症包括第三阶段的一次穿孔和一次脱出。无探头放置可缩短器械植入时间，但不会减少疼痛。有必要进行大规模研究，以评估不探查和不使用超声波检查时的并发症发生率。

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引用次数: 0

“I WORK WITH WHAT I HAVE”: MANAGING MEDICATION ABORTION AND MISCARRIAGE IN THE UNHOUSED COMMUNITY "我尽我所能"：无房社区的药物流产和流产管理

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110588

LE Adams, MJ Arzate, KR Barnes, J Karlin

Objectives

We sought to provide better support to houseless individuals’ experiences with medication abortion.

Methods

We recruited pregnancy-capable persons from Sacramento between the ages of 18-55 who had experienced an abortion or miscarriage, were currently or previously unhoused, and spoke English. Fifteen, 30-minute interviews were conducted where participants were asked about their medication abortion or miscarriage experience, and how they would manage a medication abortion while unhoused given their experience. Inductive and deductive coding were utilized for theme development.

Results

Unmet needs fell into three main categories: (1) lack of access to a safe location to complete a medication abortion including hygiene facilities; (2) lack of social support including childcare and communication from their provider throughout and after the medication abortion; and (3) a lack of access to appropriate supplies including pain and bleeding management supplies.

Conclusions

Houseless individuals have specific experiences with medication abortion which lead to unique, and unmet, needs when compared with the general population of pregnancy-capable people. Public health providers can ensure patient-centered care by providing them with appropriate resources, such as social services and material goods, to navigate their abortion plan beyond the clinic. Next steps include offering these services and supplies to this population and assessing if the medication abortion experience is improved.

方法我们从萨克拉门托招募了 18-55 岁之间有怀孕能力的人，他们都有过堕胎或流产经历，目前或以前没有住房，会讲英语。我们对参与者进行了 15 次 30 分钟的访谈，询问他们药物流产或流产的经历，以及根据他们的经历，在没有住房的情况下如何处理药物流产。结果未满足的需求主要分为三类：(1) 缺乏完成药物流产的安全地点，包括卫生设施；(2) 缺乏社会支持，包括儿童保育以及在药物流产的整个过程中和之后与医疗服务提供者的沟通；(3) 缺乏适当的用品，包括止痛和止血用品。公共卫生服务提供者可以通过向他们提供适当的资源（如社会服务和物质产品）来确保以患者为中心的护理，使他们能够在诊所之外完成流产计划。接下来的步骤包括向这些人群提供这些服务和用品，并评估药物流产的体验是否得到改善。

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引用次数: 0

CHANGES IN BELIEFS ABOUT ABORTION SAFETY IN A NATIONALLY REPRESENTATIVE SAMPLE BETWEEN 2022 AND 2023 2022 至 2023 年间全国代表性样本中有关堕胎安全的观念变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110589

R Schroeder, L Ralph, A Becker, S Kaller, MA Biggs

Objectives

We aimed to estimate changes in beliefs about abortion safety among the US population assigned female at birth (AFAB) before and after Dobbs v Jackson Women’s Health Organization.

Methods

We administered two serial cross-sectional surveys to English- or Spanish-speaking members of a nationally-representative panel of AFAB respondents, ages 15-49, pre-Dobbs (December 2021/January 2022; n=6,943) and post-Dobbs (June/July 2023; n=3,533). We asked participants to indicate whether they agree (ranging from strongly disagree to strongly agree) “that it is usually safe for a pregnant person to end a pregnancy", by (1) having an in-clinic abortion procedure; (2) using abortion pills obtained at a clinic or doctor’s office; and (3) using abortion pills obtained outside the formal healthcare system. Using weighted logistic regression models with year as the independent variable, we assessed changes in safety beliefs pre- to post-Dobbs, both overall and among subgroups.

Results

Between 2022 and 2023, the proportion of respondents agreeing that each abortion method was “usually safe” increased: in-clinic procedure: 57.8% to 64.1% (p<0.001); in-clinic medication abortion: 52.2% to 59.6% (p<0.001); and pills obtained outside of the formal healthcare system: 7.4% to 9.6% (p<0.001). In stratified analyses, subgroups associated with increased endorsement of safety between years included respondents identifying as a Democrat, with no history of abortion, and who support in-clinic procedural abortion legality (p<0.05 for all abortion method outcomes).

Conclusions

In a nationally representative sample, belief that abortion methods are safe increased between 2022 and 2023 despite increasing abortion restrictions and policies claiming abortion is unsafe. Still, public knowledge about abortion safety remains low.

方法我们在多布斯诉杰克逊妇女健康组织案之前（2021 年 12 月/2022 年 1 月；n=6943）和多布斯案之后（2023 年 6 月/7 月；n=3533）对具有全国代表性的 15-49 岁 AFAB 受访者小组中讲英语或西班牙语的成员进行了两次连续横断面调查。我们要求参与者通过以下方式表明他们是否同意（从非常不同意到非常同意）"孕妇结束妊娠通常是安全的"：(1) 在诊所内进行人工流产手术；(2) 使用在诊所或医生办公室获得的人工流产药片；(3) 使用在正规医疗系统外获得的人工流产药片。使用以年份为自变量的加权逻辑回归模型，我们评估了从多布斯事件前到多布斯事件后安全观念的变化，包括总体变化和各亚组之间的变化：57.8%增至64.1%（p<0.001）；诊所内药物流产：52.2%增至59.6%（p<0.001）：52.2%增至59.6%（p<0.001）；在正规医疗系统外获得的药片：7.4%增至9.6%（p<0.001）。在分层分析中，与不同年份间安全性认可度增加相关的亚组包括认同民主党、无人工流产史以及支持诊所内程序性人工流产合法性的受访者（所有人工流产方法结果的 p<0.05 ）。结论在一个具有全国代表性的样本中，尽管人工流产限制和声称人工流产不安全的政策不断增加，但在 2022 年至 2023 年期间，人们对人工流产方法安全性的信念有所增加。然而，公众对堕胎安全的了解仍然较少。

{"title":"CHANGES IN BELIEFS ABOUT ABORTION SAFETY IN A NATIONALLY REPRESENTATIVE SAMPLE BETWEEN 2022 AND 2023","authors":"R Schroeder, L Ralph, A Becker, S Kaller, MA Biggs","doi":"10.1016/j.contraception.2024.110589","DOIUrl":"10.1016/j.contraception.2024.110589","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate changes in beliefs about abortion safety among the US population assigned female at birth (AFAB) before and after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>We administered two serial cross-sectional surveys to English- or Spanish-speaking members of a nationally-representative panel of AFAB respondents, ages 15-49, pre-<em>Dobbs</em> (December 2021/January 2022; n=6,943) and post-<em>Dobbs</em> (June/July 2023; n=3,533). We asked participants to indicate whether they agree (ranging from strongly disagree to strongly agree) “that it is usually safe for a pregnant person to end a pregnancy\", by (1) having an in-clinic abortion procedure; (2) using abortion pills obtained at a clinic or doctor’s office; and (3) using abortion pills obtained outside the formal healthcare system. Using weighted logistic regression models with year as the independent variable, we assessed changes in safety beliefs pre- to post-<em>Dobbs</em>, both overall and among subgroups.</div></div><div><h3>Results</h3><div>Between 2022 and 2023, the proportion of respondents agreeing that each abortion method was “usually safe” increased: in-clinic procedure: 57.8% to 64.1% (p<0.001); in-clinic medication abortion: 52.2% to 59.6% (p<0.001); and pills obtained outside of the formal healthcare system: 7.4% to 9.6% (p<0.001). In stratified analyses, subgroups associated with increased endorsement of safety between years included respondents identifying as a Democrat, with no history of abortion, and who support in-clinic procedural abortion legality (p<0.05 for all abortion method outcomes).</div></div><div><h3>Conclusions</h3><div>In a nationally representative sample, belief that abortion methods are safe increased between 2022 and 2023 despite increasing abortion restrictions and policies claiming abortion is unsafe. Still, public knowledge about abortion safety remains low.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110589"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

PHARMACIST PERSPECTIVES ON PRESCRIBING MEDICATION ABORTION: FINDINGS FROM A QUALITATIVE STUDY OF CALIFORNIA PHARMACISTS 药剂师对药物流产处方的看法：对加利福尼亚药剂师的定性研究结果

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110592

JJ Serpico, C Cohen, L Serrano, RM Beltran

Objectives

We aimed to explore pharmacist attitudes toward dispensing and prescribing medication abortion.

Methods

Semi-structured interviews were conducted among 30 practicing licensed California pharmacists from October 2022 to July 2023. Participants were recruited through snowball sampling with a focus on attaining a diverse sample. Twenty-nine interviews were analyzed. Key themes were identified using Hamilton’s (2019) Rapid Qualitative Analysis Approach.

Results

Five key themes emerged: (1) pharmacists strongly supported pharmacist-dispensed medication abortion; (2) pharmacists expressed qualified support for pharmacist-prescribed medication abortion; (3) pharmacists were concerned about legality and liability in the abortion context; (4) pharmacists both endorsed and critiqued abortion stigma; and (5) pharmacists articulated various visions of their appropriate role in care provision. Almost all pharmacists supported dispensing medication abortion. While most expressed some support for prescribing medication for abortion, many expressed concerns, primarily around the themes of legality/liability and abortion stigma, as well as two prescribing sub-themes: training needs and logistical/operational barriers. Pharmacists lacked clarity around legality and desired legal protections, including for providing medication abortion to out-of-state patients. Pharmacists expressed concerns about protestors or community backlash and endorsed the belief that abortion patients may need mental health counseling, which they did not feel equipped to provide. Some pharmacists highlighted their role as accessible healthcare providers with increasing responsibility, while others emphasized having distinct roles from prescribing providers. Overall, pharmacists emphasized providing non-judgmental care, including dispensing medication for abortion without questioning the patient’s or prescribing provider’s judgment.

Conclusions

Our results provide preliminary evidence that a meaningful portion of pharmacists may be open to prescribing medication abortion, if expressed concerns are addressed.

方法 2022 年 10 月至 2023 年 7 月，我们对加利福尼亚州 30 名执业药剂师进行了半结构式访谈。我们通过滚雪球抽样的方式招募参与者，重点是获得多元化的样本。对 29 个访谈进行了分析。结果出现了五个关键主题：（1）药剂师强烈支持药剂师配药流产；（2）药剂师对药剂师处方药物流产表示有条件的支持；（3）药剂师关注流产背景下的合法性和责任；（4）药剂师既赞同又批评流产耻辱化；以及（5）药剂师阐述了他们在提供护理中的适当角色的各种愿景。几乎所有药剂师都支持配药流产。虽然大多数药剂师对开具药物流产处方表示了一定的支持，但许多药剂师也表达了担忧，主要围绕合法性/责任和流产耻辱感这两个主题，以及两个处方次主题：培训需求和后勤/操作障碍。药剂师对合法性和所需的法律保护缺乏明确认识，包括向州外患者提供药物流产。药剂师表达了对抗议者或社区反弹的担忧，并赞同堕胎患者可能需要心理健康咨询的观点，但他们认为自己不具备提供心理健康咨询的能力。一些药剂师强调他们的角色是无障碍医疗服务提供者，责任越来越大，而另一些药剂师则强调他们的角色与处方提供者截然不同。总体而言，药剂师强调提供非评判性的护理，包括在不质疑患者或处方提供者的判断的情况下配药流产。结论我们的研究结果提供了初步证据，表明如果所表达的顾虑得到解决，相当一部分药剂师可能对开具药物流产处方持开放态度。

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引用次数: 0

TRENDS IN OUT-OF-STATE ABORTIONS IN OREGON FOLLOWING THE DOBBS COURT DECISION 多布斯法院判决后俄勒冈州外堕胎的趋势

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110571

M Fuerst, A Mandelbaum, E Nacev, M Rodriguez

Objectives

This study looks at how out-of-state travel for abortion care changed in the state of Oregon following the Dobbs v Jackson Women’s Health Organization decision on June 24, 2022.

Methods

This was a cross-sectional study using data from the Oregon Health Authority (OHA), which collects information on all abortions performed in Oregon. Our sample included all medication and procedural abortions between January 1, 2015 and September 30, 2023. For the post-Dobbs cohort, we compared in-state with out-of-state residents using standard bivariate analyses. We then conducted an interrupted time series analysis to trend the proportion of out-of-state residents following Dobbs.

Results

Our sample included 66,253 abortions. In the post-Dobbs cohort, out-of-state residents were significantly more likely to have a procedural vs. a medication abortion (51.65% vs. 46.7%) and be at higher gestational ages at the time of their procedure. Our ITS analysis estimated that the number of out-of-state residents would increase by 2.61% (95% CI, 1.2–3.93%). After Dobbs, out-of-state residents came to Oregon from 24 US states with a wide geographical spread.

Conclusions

The Dobbs decision increased the proportion of individuals traveling from out-of-state to Oregon for abortion care. These individuals were more likely to have a procedural abortion and to be at more advanced gestational ages. As the post-Roe v Wade abortion landscape continues to evolve, it is important to understand the demographics and needs of those traveling for abortion care.

本研究探讨了在 2022 年 6 月 24 日 Dobbs 诉杰克逊妇女健康组织案判决后，俄勒冈州州外堕胎护理旅行发生了哪些变化。我们的样本包括 2015 年 1 月 1 日至 2023 年 9 月 30 日期间的所有药物流产和程序流产。对于后多布斯队列，我们使用标准的双变量分析比较了州内和州外居民。然后，我们进行了中断时间序列分析，以确定多布斯之后州外居民的比例趋势。在后多布斯队列中，州外居民进行程序性流产的可能性明显高于药物流产（51.65% 对 46.7%），并且在进行程序性流产时的妊娠年龄也更高。我们的 ITS 分析估计，州外居民的数量将增加 2.61%（95% CI，1.2-3.93%）。结论多布斯决定增加了从外州前往俄勒冈州接受堕胎护理的人数比例。这些人更有可能进行程序性流产，而且妊娠年龄更大。随着 "罗伊诉韦德案 "后人工流产形势的不断发展，了解前往俄勒冈州接受人工流产护理的人群特征和需求非常重要。

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引用次数: 0

ABORTION CARE IN THE EMERGENCY DEPARTMENT: A NATIONAL SURVEY OF EMERGENCY MEDICINE PHYSICIANS’ PERSPECTIVES 急诊科的堕胎护理：全国急诊科医生观点调查

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110594

AM Kempf, MR Singer, M Haas-Kogan, A Pelletier, AB Friedman, S Easter, DA Bartz

Objectives

The emergency department is a common setting of unintended pregnancy diagnoses, particularly for patients with limited access to healthcare. Reproductive health services can be provided in the emergency setting to expand care for this population, especially important post Dobbs v Jackson Women’s Health Organization. This study seeks to assess emergency medicine physicians’ current knowledge, attitudes, and practices, before and after Dobbs, related to pregnancy options counseling, referrals, and provision of induced abortion in the emergency department.

Methods

We surveyed a sample of emergency medicine physicians at a national meeting regarding knowledge, attitudes, and practices related to reproductive healthcare delivery. Kruskall-Wallis tests were used to evaluate differences between abortion restrictive and permissive states and chi-squared tests were used to compare proportions between the two groups. Thematic analysis was used to review qualitative responses.

Results

A total of 252 emergency medicine physicians completed the survey, 218 (86.5%) from abortion permissive and 30 (11.9%) from abortion restrictive states. Most (n=178, 70.6%) supported abortion provision in the emergency department if legally allowed although only about half (n=131, 52.0%) report ever prescribing medication abortion pills. Only 27 (10.7%) report possessing enough knowledge or having received adequate training to independently prescribe medication abortion.

Conclusions

Abortion can and should be provided in the emergency department, especially in an attempt to expand access to reproductive healthcare after the Dobbs decision. While most emergency medicine physicians support the provision of abortion care this setting, they do not routinely provide it due to a variety of factors including lack of knowledge, lack of training, and legal/institutional restrictions.

目标急诊科是诊断意外怀孕的常见场所，尤其是对那些医疗条件有限的患者而言。可以在急诊环境中提供生殖健康服务，以扩大对这一人群的护理，这在多布斯诉杰克逊妇女健康组织案之后尤为重要。本研究旨在评估急诊科医生在多布斯案前后对妊娠选择咨询、转诊以及在急诊科提供人工流产服务的现有知识、态度和实践。我们使用 Kruskall-Wallis 检验来评估限制堕胎州和允许堕胎州之间的差异，并使用卡方检验来比较两组之间的比例。结果共有 252 名急诊科医生完成了调查，其中 218 人（86.5%）来自允许堕胎的州，30 人（11.9%）来自限制堕胎的州。大多数医生（178 人，占 70.6%）支持在法律允许的情况下在急诊科提供人工流产服务，但只有约半数医生（131 人，占 52.0%）表示曾开过药物流产药方。只有 27 人（10.7%）表示拥有足够的知识或接受过足够的培训，可以独立开具药物流产处方。结论急诊科可以也应该提供人工流产服务，尤其是在多布斯案判决后，为了扩大生殖医疗服务的可及性。虽然大多数急诊科医生都支持在这种情况下提供人工流产护理，但由于缺乏知识、缺乏培训以及法律/机构限制等多种因素，他们并不经常提供人工流产护理。

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引用次数: 0

ASSESSING THE IMPACT OF HEALTH EQUITY-INFORMED QUALITY IMPROVEMENT ON CONTRACEPTIVE CARE SCREENING, COUNSELING, AND PROVISION 评估注重健康公平的质量改进对避孕护理筛查、咨询和提供的影响

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110576

EE Wingo, D Hessler-Jones, L Gibson, S Goetsch-Avila, R Kriz, C Dehlendorf

Objectives

Improving contraceptive care quality is crucial to optimizing people’s reproductive health and achieving reproductive health equity. We assessed the impact of a health equity-focused quality improvement learning collaborative (QILC) on the quality of contraceptive care at community health centers (CHCs) through innovative, person-centered performance measurement.

Methods

We developed a nine-month QILC comprising monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources and strategies, peer-learning opportunities, and technical assistance. CHCs collected Person-Centered Contraceptive Counseling (PCCC) measure surveys from patients pre-post QILC to assess contraceptive counseling. CHCs implemented a novel health service needs-based contraception screening question, the Self-Identified Need for Contraception (SINC), into their EHRs. EHR data were extracted to calculate standardized electronic clinical quality measures (eCQMs) of contraceptive use. To assess intervention impact, we compared PCCC scores, percentage of eligible patients screened with SINC, and contraceptive use before and after the QILC.

Results

Baseline PCCC scores ranged from 30% to 94%. At endline, 6 of 10 CHCs improved their PCCC score (Δ 2% to 24%) and four of those surpassed the 80% benchmark for high-quality care. At baseline, few patients were screened with SINC (range: <1% - 36%). Across sites, median increase in percentage of eligible patients screened was 10% (range: <1% - 46%). Sites observed an increase in eCQMs for use of most or moderately effective contraceptive methods (mdn change: 2%; range: [<1% -9%).

Conclusions

Participation in an equity-focused and performance measures-driven QILC led to increased person-centered screening for contraceptive need and improved contraceptive counseling.

目标提高避孕护理质量对于优化人们的生殖健康和实现生殖健康公平至关重要。我们评估了以健康公平为重点的质量改进学习合作（QILC）通过创新的、以人为本的绩效测量方法对社区卫生中心（CHCs）避孕护理质量的影响。方法我们开发了一个为期九个月的 QILC，其中包括关于生殖健康公平和以人为本的避孕护理的每月学习课程、支持资源和策略、同伴学习机会以及技术援助。社区健康中心在 QILC 结束前向患者收集了 "以人为本的避孕咨询"（PCCC）测量调查，以评估避孕咨询情况。社区健康中心在其电子健康记录（EHR）中采用了一种新颖的基于健康服务需求的避孕筛查问题，即 "自我避孕需求"（SINC）。通过提取电子病历数据来计算避孕药具使用情况的标准化电子临床质量标准（eCQMs）。为了评估干预效果，我们比较了 PCCC 分数、通过 SINC 筛查的合格患者百分比以及 QILC 实施前后的避孕药具使用情况。在终点线上，10 家社区健康中心中有 6 家的 PCCC 得分有所提高（Δ 2% 至 24%），其中 4 家超过了 80% 的优质护理基准。基线时，很少有患者接受 SINC 筛查（范围：1% - 36%）。在所有医疗点中，符合筛查条件的患者比例中位数增加了 10%（范围：1% - 46%）。各医疗点观察到使用最有效或中等有效避孕方法的 eCQMs 有所增加（mdn 变化：2%；范围：[<1% -9%]）。

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