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Abstract：
BACKGROUND: The Norwegian Government introduced in 2002 a reimbursement scheme for hormonal contraceptives to adolescents at the same time as public health nurses and midwives received authorization to prescribe hormonal contraceptives. This study examines the impact of increased accessibility and public funding on hormonal contraceptive use among adolescents.
METHODS: The Norwegian Prescription Database, Statistics Norway, and Norwegian Institute of Public Health served as data sources for this cohort study. The study population comprised 174 653 Norwegian women born 1989-1990, 1994-1995, and 1999-2000. We examined use of hormonal contraceptives through dispensed prescriptions from age 12 through age 19 with duration of first continuous use as primary outcome. The statistical analyses were done in SPSS using chi-squared test, survival analysis, and Joinpoint regression analysis with p-values < 0.05.
RESULTS: By age 19, ~75% of the cohorts had used at least one hormonal method. The main providers of the first prescription were general practitioners and public health nurses. Starters of progestogen-only pills (POPs) have increased across the cohorts, while starters of combined oral contraceptives (COCs) have decreased. The use of long-acting reversible contraceptives (LARCs) has increased since its inclusion in the reimbursement scheme (2015). Most switchers shifted from COCs or POPs as a start method to implants after LARCs became part of the reimbursement scheme. There has been a significant increase across the cohorts in the number of women who continuously used hormonal contraceptives from start to the end of the calendar year they became 19 years with the same method and after switching methods. We could not correlate changes in decreasing trends for teenage births or induced abortions (Joinpoint analysis) to time for implementation or changes in the reimbursement of hormonal contraceptives from 2002.
CONCLUSIONS: Primarily public health nurses and to a lesser extent midwives became soon after they received authorization to prescribe COCs important providers. The expansion of the reimbursement scheme to cover POPs, patches, vaginal ring, and depot medroxyprogesterone acetate in 2006 had minor impact on increasing the proportion of long-term first-time users. However, the inclusion of LARCs in 2015 significantly increased the proportion of long-term first-time hormonal contraceptive users.
METHODS: The Norwegian Prescription Database, Statistics Norway, and Norwegian Institute of Public Health served as data sources for this cohort study. The study population comprised 174 653 Norwegian women born 1989-1990, 1994-1995, and 1999-2000. We examined use of hormonal contraceptives through dispensed prescriptions from age 12 through age 19 with duration of first continuous use as primary outcome. The statistical analyses were done in SPSS using chi-squared test, survival analysis, and Joinpoint regression analysis with p-values < 0.05.
RESULTS: By age 19, ~75% of the cohorts had used at least one hormonal method. The main providers of the first prescription were general practitioners and public health nurses. Starters of progestogen-only pills (POPs) have increased across the cohorts, while starters of combined oral contraceptives (COCs) have decreased. The use of long-acting reversible contraceptives (LARCs) has increased since its inclusion in the reimbursement scheme (2015). Most switchers shifted from COCs or POPs as a start method to implants after LARCs became part of the reimbursement scheme. There has been a significant increase across the cohorts in the number of women who continuously used hormonal contraceptives from start to the end of the calendar year they became 19 years with the same method and after switching methods. We could not correlate changes in decreasing trends for teenage births or induced abortions (Joinpoint analysis) to time for implementation or changes in the reimbursement of hormonal contraceptives from 2002.
CONCLUSIONS: Primarily public health nurses and to a lesser extent midwives became soon after they received authorization to prescribe COCs important providers. The expansion of the reimbursement scheme to cover POPs, patches, vaginal ring, and depot medroxyprogesterone acetate in 2006 had minor impact on increasing the proportion of long-term first-time users. However, the inclusion of LARCs in 2015 significantly increased the proportion of long-term first-time hormonal contraceptive users.
摘要：
背景：2002年，在公共卫生护士和助产士获得处方激素避孕药的授权的同时，挪威政府向青少年推出了激素避孕药的报销计划。这项研究考察了增加可及性和公共资金对青少年使用激素避孕药具的影响。
方法：挪威处方数据库，挪威统计局，和挪威公共卫生研究所作为本队列研究的数据来源。研究人群包括1989-1990年，1994-1995年和1999-2000年出生的174653名挪威妇女。我们通过从12岁到19岁的处方来检查激素避孕药的使用情况，并将首次连续使用的持续时间作为主要结果。统计分析采用SPSS卡方检验，生存分析,和Joinpoint回归分析，p值<0.05。
结果：到19岁时，约75％的队列至少使用了一种激素方法。第一个处方的主要提供者是全科医生和公共卫生护士。仅含孕激素的药丸（POPs）的开始在整个队列中增加，而联合口服避孕药（COCs）的起子有所减少。长效可逆避孕药（LARCs）的使用自纳入报销计划（2015年）以来一直在增加。在LARC成为报销计划的一部分之后，大多数转换者从COC或POP作为开始方法转移到植入物。在整个队列中，从日历年开始到结束时连续使用激素避孕药的妇女人数显着增加，她们以相同的方法和切换方法后成为19岁。我们无法将少女分娩或人工流产（Joinpoint分析）下降趋势的变化与实施时间或从2002年开始激素避孕药报销的变化相关联。
结论：主要是公共卫生护士和较小程度的助产士在获得处方COCs的授权后不久就成为重要的提供者。扩大偿还计划，以涵盖持久性有机污染物，补丁,阴道环,2006年的醋酸甲羟孕酮对增加长期首次使用者的比例影响较小。然而,2015年纳入LARCs显著增加了长期首次使用激素避孕药的比例.
方法：挪威处方数据库，挪威统计局，和挪威公共卫生研究所作为本队列研究的数据来源。研究人群包括1989-1990年，1994-1995年和1999-2000年出生的174653名挪威妇女。我们通过从12岁到19岁的处方来检查激素避孕药的使用情况，并将首次连续使用的持续时间作为主要结果。统计分析采用SPSS卡方检验，生存分析,和Joinpoint回归分析，p值<0.05。
结果：到19岁时，约75％的队列至少使用了一种激素方法。第一个处方的主要提供者是全科医生和公共卫生护士。仅含孕激素的药丸（POPs）的开始在整个队列中增加，而联合口服避孕药（COCs）的起子有所减少。长效可逆避孕药（LARCs）的使用自纳入报销计划（2015年）以来一直在增加。在LARC成为报销计划的一部分之后，大多数转换者从COC或POP作为开始方法转移到植入物。在整个队列中，从日历年开始到结束时连续使用激素避孕药的妇女人数显着增加，她们以相同的方法和切换方法后成为19岁。我们无法将少女分娩或人工流产（Joinpoint分析）下降趋势的变化与实施时间或从2002年开始激素避孕药报销的变化相关联。
结论：主要是公共卫生护士和较小程度的助产士在获得处方COCs的授权后不久就成为重要的提供者。扩大偿还计划，以涵盖持久性有机污染物，补丁,阴道环,2006年的醋酸甲羟孕酮对增加长期首次使用者的比例影响较小。然而,2015年纳入LARCs显著增加了长期首次使用激素避孕药的比例.
