PDF(Pubmed)
Abstract：
BACKGROUND: The etonogestrel contraceptive implant is currently approved by the United States Food and Drug Administration (FDA) for the prevention of pregnancy up to 3 years. However, studies that suggest efficacy up to 5 years. There is little information on the prevalence of extended use and the factors that influence clinicians in offering extended use. We investigated clinician perspectives on the barriers and facilitators to offering extended use of the contraceptive implant.
METHODS: Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively.
RESULTS: We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators.
CONCLUSIONS: There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years.
METHODS: Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively.
RESULTS: We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators.
CONCLUSIONS: There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years.
摘要：
背景：依托孕烯避孕植入物目前已获得美国食品和药物管理局（FDA）的批准，用于预防长达3年的怀孕。然而,研究表明疗效长达5年。关于延长使用的患病率以及影响临床医生提供延长使用的因素的信息很少。我们调查了临床医生对提供长期使用避孕植入物的障碍和促进因素的看法。
方法：使用实施研究综合框架(CFIR)，我们进行了半结构化的定性访谈。参与者是从一项针对生殖健康临床医生的全国性调查研究中招募的，这些研究涉及他们对避孕植入物的广泛使用的知识和观点。为了优化视角的多样性，我们有目的地对这项研究的参与者进行抽样.我们使用内容分析和合意的定性研究方法来为我们的编码和数据分析提供信息。主题是演绎和归纳产生的。
结果：我们采访了20名临床医生，包括高级执业临床医生，家庭医生，产科医生/妇科医生和复杂的计划生育专家。出现了有关延长使用避孕植入物的障碍和促进因素的主题。障碍包括FDA批准3年，以及临床医生对标签外使用避孕植入物的责任的关注。教育材料和广泛使用的拥护者是促进者。
结论：通过为临床医生和患者编写教育材料，有机会扩大避孕植入物的使用范围，确定延长使用的拥护者，并在3年更换任命之前提供有关延长使用的信息。
方法：使用实施研究综合框架(CFIR)，我们进行了半结构化的定性访谈。参与者是从一项针对生殖健康临床医生的全国性调查研究中招募的，这些研究涉及他们对避孕植入物的广泛使用的知识和观点。为了优化视角的多样性，我们有目的地对这项研究的参与者进行抽样.我们使用内容分析和合意的定性研究方法来为我们的编码和数据分析提供信息。主题是演绎和归纳产生的。
结果：我们采访了20名临床医生，包括高级执业临床医生，家庭医生，产科医生/妇科医生和复杂的计划生育专家。出现了有关延长使用避孕植入物的障碍和促进因素的主题。障碍包括FDA批准3年，以及临床医生对标签外使用避孕植入物的责任的关注。教育材料和广泛使用的拥护者是促进者。
结论：通过为临床医生和患者编写教育材料，有机会扩大避孕植入物的使用范围，确定延长使用的拥护者，并在3年更换任命之前提供有关延长使用的信息。
