Study Objectives

Many pediatric providers serving adolescents are not trained to offer comprehensive contraceptive services, including intrauterine devices (IUDs) and implants, despite high safety and satisfaction among adolescents. This study assessed an initiative to train providers at school-based health centers (SBHCs) to offer students the full range of contraceptive methods.

Design

Surveys were administered at baseline pre-training and at follow-up 3 months post-training. Data were analyzed using generalized estimating equations for clustered data to examine clinical practice changes.

Setting

Eleven contraceptive trainings at SBHCs across the United States from 2016-2019.

Participants

A total of 260 providers from 158 SBHCs serving 135,800 students.

Interventions

On-site training to strengthen patient-centered counseling and to equip practitioners to integrate IUDs and implants into contraceptive services.

Main Outcome Measures

The outcomes included counseling experience on IUDs and implants, knowledge of patient eligibility, and clinician method skills.

Results

At follow-up, providers were significantly more likely to report having enough experience to counsel on IUDs (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.62-6.36]) and implants (aOR, 3.06; 95% CI, 2.05-4.57). Provider knowledge about patient eligibility for IUDs, including for adolescents, increased (P < .001). Providers were more likely to offer same-visit IUD (aOR, 2.10; 95% CI, 1.41-3.12) and implant services (aOR, 1.66; 95% CI, 1.44-1.91). Clinicians’ skills with contraceptive devices improved, including for a newly available low-cost IUD (aOR, 2.21; 95% CI, 1.45-3.36).

Conclusions

Offering evidence-based training is a promising approach to increase counseling and access to comprehensive contraceptive services at SBHCs.

中文翻译：

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提高学校卫生中心为青少年提供咨询和获得综合避孕服务的能力。

学习目标

尽管青少年的安全性和满意度很高，但许多为青少年提供服务的儿科服务提供者并未接受过提供全面避孕服务（包括宫内节育器 (IUD) 和植入物）的培训。这项研究评估了一项培训校内健康中心 (SBHC) 提供者的举措，以便为学生提供全方位的避孕方法。

设计

在培训前的基线和培训后 3 个月的随访中进行了调查。使用聚类数据的广义估计方程对数据进行分析，以检查临床实践的变化。

环境

2016 年至 2019 年在美国各地的 SBHC 举办了 11 次避孕培训。

参加者

来自 158 个 SBHC 的 260 家服务提供者为 135,800 名学生提供服务。

干预措施

现场培训，以加强以患者为中心的咨询，并帮助从业人员将宫内节育器和植入物纳入避孕服务。

主要观察指标

结果包括宫内节育器和植入物的咨询经验、患者资格知识以及临床医生的方法技能。

结果

随访时，提供者更有可能报告有足够的经验来就宫内节育器（调整后优势比 [aOR]，4.08；95% 置信区间 [CI]，2.62-6.36]）和植入物（aOR，3.06；95）提供咨询。 % CI，2.05-4.57）。提供者对患者（包括青少年）是否适合使用宫内节育器的了解有所增加 ( P  < .001)。提供者更有可能提供同次就诊宫内节育器（aOR，2.10；95% CI，1.41-3.12）和植入服务（aOR，1.66；95% CI，1.44-1.91）。临床医生使用避孕器具的技能有所提高，包括使用新推出的低成本宫内节育器（aOR，2.21；95% CI，1.45-3.36）。

结论

提供循证培训是一种很有前途的方法，可以增加 SBHC 的咨询和获得全面避孕服务的机会。