在美国门诊期间提供的设施和临床医生特征与计划生育服务之间的关系。

IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Womens Health Issues Pub Date : 2023-11-01 DOI:10.1016/j.whi.2023.06.008
Alex Schulte BS , M. Antonia Biggs PhD
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引用次数: 0

摘要

导言:疾病控制和预防中心的最新指南强调了获得全面计划生育服务的重要性,并建议将以患者为中心的避孕咨询纳入育龄个体的常规初级保健就诊。本研究旨在描述计划生育服务提供在门诊护理设置和评估差异的设施和临床医生的特点。方法:使用全国门诊医疗调查数据(一项具有全国代表性的门诊就诊调查),我们通过设施位置、设施类型、医生专业、就诊的临床医生类型以及患者是否由其初级保健提供者就诊来评估计划生育服务的提供。我们使用具有稳健标准误差的随机截距逻辑回归,调整患者特征以及状态和年份固定效应。结果:分析样本包括2011年至2019年期间53,489名育龄(15-49岁)患者就诊。计划生育服务占总抽样访问的8%,与农村地区相比,城市地区更有可能提供计划生育服务(调整后的优势比为1.45;P = .02)和社区卫生中心与私人医生执业相比(校正优势比为1.74;p = .00)。与只看医生相比,当病人看助理医生或护士时,更有可能得到计划生育服务。在控制观察到的协变量后,临床医生间异质性的测量表明,临床医生提供计划生育服务的差异很大。结论:计划生育服务更有可能在城市地区、社区卫生中心和患者接受团队护理时提供。临床医生之间的巨大差异表明,需要更好地将计划生育服务纳入初级保健和其他门诊设置,以满足患者的需求和偏好。
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Association Between Facility and Clinician Characteristics and Family Planning Services Provided During U.S. Outpatient Care Visits

Introduction

Recent guidelines from the Centers for Disease Control and Prevention emphasize the importance of access to comprehensive family planning services and recommend patient-centered contraceptive counseling be incorporated into routine primary care visits for reproductive-age individuals. This study aims to describe family planning service provision in outpatient care settings and assess differences by facility and clinician characteristics.

Methods

Using National Ambulatory Medical Care Survey data, a nationally representative survey of outpatient care visits, we assessed family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and whether the patient was seen by their primary care provider. We used random intercept logistic regression with robust standard errors, adjusting for patient characteristics, and state and year fixed effects.

Results

The analytic sample included 53,489 patient visits with reproductive-age (15–49 years) individuals between 2011 and 2019. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas (adjusted odds ratio, 1.45; p = .02) and at community health centers compared with private physician practices (adjusted odds ratio, 1.74; p = .00). Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity indicate wide variation in which clinicians provided family planning services.

Conclusions

Family planning services were more likely to be provided in urban areas, at community health centers, and when patients received team-based care. The wide variation between clinicians suggests a need to better incorporate family planning services into primary care and other outpatient settings to meet patient needs and preferences.

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来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
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