在孟加拉国,由医疗机构管理的药物流产与由药房提供的自我管理流产的质量比较。

IF 3.4 3区 医学 Q1 FAMILY STUDIES BMJ Sexual & Reproductive Health Pub Date : 2024-01-09 DOI:10.1136/bmjsrh-2023-201931
Laura E Jacobson, Sarah E Baum, Erin Pearson, Rezwana Chowdhury, Nirali M Chakraborty, Julia M Goodman, Caitlin Gerdts, Blair G Darney
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引用次数: 0

摘要

目的:我们使用新开发的人工流产护理质量工具(ACQTool)来比较孟加拉国不同来源(由医疗机构管理的人工流产与由药房提供的自我管理人工流产(SMA))的客户报告的药物流产护理质量:我们利用在非政府组织(NGO)支持或运营的公共和私营部门机构以及孟加拉国三个地区的药房收集的退出调查和 30 天随访调查来开发和验证 ACQTool。我们使用二元统计法比较了客户报告的 18 项质量指标,这些指标按来源(医疗机构与药房)分为 6 个领域和 8 个流产结果。我们使用多变量逻辑回归来确定与选定的质量指标和结果(人工流产的可负担性、信息提供和了解不良事件的处理方法)相关的因素,同时控制客户的社会人口特征:在 550 名人工流产患者中,146 人(26.5%)接受了由医疗机构管理的药物流产,404 人(73.5%)接受了由药房提供的 SMA。在五项指标上,患者认为医疗机构的质量更高,在两项指标上,药房的质量更高;其余 11 项指标在来源上没有差异。与机构客户相比,药房客户报告堕胎费用可负担的几率更高(调整后的几率比(aOR)为 3.55;95% CI 为 2.27 至 5.58),但报告信息提供率高的几率较低(aOR 为 0.14;95% CI 为 0.09 至 0.23)。八项人工流产结果中有七项无差异;药房客户知道发生不良事件时该怎么办的几率较低(aOR 0.45;95% CI 0.23 至 0.82):在孟加拉国,就大多数质量和结果指标而言,医疗机构和药房在客户报告的药物流产护理质量方面没有差异。然而,医疗机构提供的信息和准备工作质量更高,而药店的价格更实惠。
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Client-reported quality of facility-managed medication abortion compared with pharmacy-sourced self-managed abortion in Bangladesh.

Objective: We used the newly developed Abortion Care Quality Tool (ACQTool) to compare client-reported quality of medication abortion care by source (facility-managed vs pharmacy-sourced self-managed abortion (SMA)) in Bangladesh.

Methods: We leveraged exit and 30-day follow-up surveys collected to develop and validate the ACQTool collected at nongovernmental organisation (NGO)-supported or -operated facilities in the public and private sector and pharmacies from three districts in Bangladesh. We used bivariate statistics to compare 18 client-reported quality indicators grouped in six domains and eight abortion outcomes, by source (facility vs pharmacy). We used multivariable logistic regression to identify factors associated with selected quality indicators and outcomes (abortion affordability, information provision, and knowing what to do for an adverse event), controlling for client sociodemographic characteristics.

Results: Of 550 abortion clients, 146 (26.5%) received a facility-managed medication abortion and 404 (73.5%) had a pharmacy-sourced SMA. Clients reported higher quality in facilities for five indicators, and higher in pharmacies for two indicators; the remaining 11 indicators were not different by source. Compared with facility-based clients, pharmacy clients had higher odds of reporting that the cost of abortion was affordable (adjusted odds ratio (aOR) 3.55; 95% CI 2.27 to 5.58) but lower odds of reporting high information provision (aOR 0.14; 95% CI 0.09 to 0.23). Seven of eight abortion outcomes showed no differences; pharmacy clients had lower odds of knowing what to do if an adverse event occurred (aOR 0.45; 95% CI 0.23 to 0.82).

Conclusions: In Bangladesh, there is no difference in client-reported quality of medication abortion care between health facilities and pharmacies for the majority of quality and outcome indicators. However, information provision and preparedness were higher quality at facilities, while pharmacies were more affordable.

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来源期刊
BMJ Sexual & Reproductive Health
BMJ Sexual & Reproductive Health Medicine-Reproductive Medicine
CiteScore
5.10
自引率
6.10%
发文量
38
期刊介绍: BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.
期刊最新文献
Shifting discourses, changing interests? How the language of sexual and reproductive health has evolved in the past 50 years. "That's not how abortions happen": a qualitative study exploring how young adults navigate abortion misinformation in the post-Roe era. Attitudes towards the regulation and provision of abortion among healthcare professionals in Britain: cross-sectional survey data from the SACHA Study. Reported side effects from hormonal contraceptives among those seeking abortion care versus contraceptive services. The post-Roe potential of mifepristone and misoprostol in the United States.
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