PDF(Pubmed)
Abstract：
OBJECTIVE: Learning to provide long-acting reversible contraception (LARC) during family medicine residency is an important step in building capacity for the primary care workforce to meet the reproductive health care needs of communities. We aimed to measure the impact of adding a contraceptive visit type (CVT) allowing for rapid access to contraception (RAC) on family medicine resident LARC procedure numbers.
METHODS: Our program created a CVT in which patients were seen only for contraceptive services. We added the CVT to third-year family medicine resident continuity clinic schedules and a block of CVTs (the RAC clinic) to the third-year gynecology rotation. Residents self-reported LARC procedure numbers performed throughout residency, and the totals were compared for graduating residents from 2023 (post-RAC cohort) to 2022 graduates and 2018-2022 graduates (pre-RAC cohort).
RESULTS: Post-RAC cohort residents reported a statistically significant increase in intrauterine device (IUD; P=.015) and contraceptive implant (P=.010) removals compared to the 2022 pre-RAC cohort. Insertions of IUDs and contraceptive implants were unchanged when compared to the pre-RAC cohort. IUD removals (P=.004) and insertions (P=.034), and contraceptive implant removals (P=.028) were significantly increased for post-RAC compared to 2022 graduates, with no difference in contraceptive implant insertions (P=.211).
CONCLUSIONS: The addition of the CVT and RAC clinic contributed to an increase in LARC removals in both comparisons, and IUD insertions between 2022 and 2023. This clinic model offers an opportunity for other family medicine residency programs to improve access to contraceptive services and increase resident training in LARC management.
METHODS: Our program created a CVT in which patients were seen only for contraceptive services. We added the CVT to third-year family medicine resident continuity clinic schedules and a block of CVTs (the RAC clinic) to the third-year gynecology rotation. Residents self-reported LARC procedure numbers performed throughout residency, and the totals were compared for graduating residents from 2023 (post-RAC cohort) to 2022 graduates and 2018-2022 graduates (pre-RAC cohort).
RESULTS: Post-RAC cohort residents reported a statistically significant increase in intrauterine device (IUD; P=.015) and contraceptive implant (P=.010) removals compared to the 2022 pre-RAC cohort. Insertions of IUDs and contraceptive implants were unchanged when compared to the pre-RAC cohort. IUD removals (P=.004) and insertions (P=.034), and contraceptive implant removals (P=.028) were significantly increased for post-RAC compared to 2022 graduates, with no difference in contraceptive implant insertions (P=.211).
CONCLUSIONS: The addition of the CVT and RAC clinic contributed to an increase in LARC removals in both comparisons, and IUD insertions between 2022 and 2023. This clinic model offers an opportunity for other family medicine residency programs to improve access to contraceptive services and increase resident training in LARC management.
摘要：
目的：学习在家庭医学住院期间提供长效可逆避孕（LARC）是建立初级保健人员能力以满足社区生殖保健需求的重要一步。我们旨在衡量增加避孕访问类型（CVT）的影响，以允许快速获得避孕（RAC）对家庭医学居民LARC程序编号的影响。
方法：我们的项目创建了一个CVT，其中患者仅用于避孕服务。我们将CVT添加到第三年家庭医学住院医师连续性诊所时间表中，并将CVT（RAC诊所）添加到第三年妇科轮换中。居民自我报告的LARC程序编号在整个居住期间执行，并比较了2023年（RAC后队列）至2022年毕业生和2018-2022年毕业生（RAC前队列）的毕业生总数。
结果：RAC后队列居民报告，与2022年RAC前队列相比，宫内节育器（IUD；P=0.015）和避孕植入物（P=.010）的移除量有统计学意义的增加。与RAC前队列相比，宫内节育器和避孕植入物的插入没有变化。宫内节育器去除（P=.004）和插入（P=.034），与2022年毕业生相比，RAC后的避孕植入物移除量（P=0.028）显着增加，避孕植入物的插入没有差异（P=0.211）。
结论：在两个比较中，CVT和RAC诊所的增加导致了LARC去除量的增加，和2022年至2023年之间的宫内节育器插入。这种诊所模式为其他家庭医学住院医师计划提供了机会，以改善获得避孕服务的机会，并增加LARC管理方面的住院医师培训。
方法：我们的项目创建了一个CVT，其中患者仅用于避孕服务。我们将CVT添加到第三年家庭医学住院医师连续性诊所时间表中，并将CVT（RAC诊所）添加到第三年妇科轮换中。居民自我报告的LARC程序编号在整个居住期间执行，并比较了2023年（RAC后队列）至2022年毕业生和2018-2022年毕业生（RAC前队列）的毕业生总数。
结果：RAC后队列居民报告，与2022年RAC前队列相比，宫内节育器（IUD；P=0.015）和避孕植入物（P=.010）的移除量有统计学意义的增加。与RAC前队列相比，宫内节育器和避孕植入物的插入没有变化。宫内节育器去除（P=.004）和插入（P=.034），与2022年毕业生相比，RAC后的避孕植入物移除量（P=0.028）显着增加，避孕植入物的插入没有差异（P=0.211）。
结论：在两个比较中，CVT和RAC诊所的增加导致了LARC去除量的增加，和2022年至2023年之间的宫内节育器插入。这种诊所模式为其他家庭医学住院医师计划提供了机会，以改善获得避孕服务的机会，并增加LARC管理方面的住院医师培训。
