Multi-level Emergency Department Intervention to Reduce Pregnancy Risk Among Adolescents

多层次急诊科干预降低青少年怀孕风险

基本信息

批准号：
9890172
负责人：
Melissa Kristine Miller
金额：
$ 25.97万
依托单位：
CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-22 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9890172
关键词：
Accident and Emergency department Address Adolescent Adolescent Medicine Advanced Practice Nurse African American Caring Characteristics Clinic Comprehensive Health Care Contraceptive Agents Contraceptive methods Counseling Data Emergency Department-based Intervention Emergency Nursing Emergency department visit Enrollment Face Feasibility Studies Female Female Adolescents Future Generations Health Health Educators Health Services Healthcare Systems Hispanics Human Resources Implant Incidence Individual Injections Intervention Knowledge Lead Length Literature Location Methodology Minority Modeling Oral Outcome Outpatients Participant Patients Positioning Attribute Poverty Pregnancy Pregnancy Rate Pregnancy in Adolescence Provider Reporting Research Risk Risk Reduction Sampling Services Sexual Health Sexually Transmitted Diseases Site Specialist System Testing Time Training Vaginal Ring Work Youth aged arm base care seeking child bearing condoms contextual factors cost design disparity reduction emergency contraception evidence base high risk high-risk adolescents hormonal contraception indexing innovation interest intervention participants motivational enhancement therapy novel novel strategies patient oriented patient-level barriers pediatric emergency pill point of care programs provider-level barriers randomized trial reproductive response sexual health intervention sexually active standard of care system-level barriers theories treatment arm unintended pregnancy uptake

项目摘要

PROJECT SUMMARY The burden of adolescent unintended pregnancy in the US is substantial, despite declines in pregnancy rates in recent years. Although highly effective contraceptive methods exist, adolescents face multi-level barriers to contraceptive access and use. Research focused on increasing contraception initiation among adolescents is crucial. The emergency department (ED) is a non-traditional setting that is well-positioned to provide reproductive care, as almost 19 million adolescents seek care in EDs each year, many are amenable to receiving care in this setting, and the ED is often the only or primary contact with the health care system for the highest-risk youth. We propose a novel contraceptive counseling intervention for the ED setting that address barriers at the patient, provider, and system levels. Building on previous work and drawing on proven strategies from traditional settings, we will train ED advanced practice nurses to provide counseling utilizing Motivational Interviewing strategies to facilitate uptake of ED-based contraception or clinic referral among sexually active females aged 15-18 years. We will conduct a small randomized trial to evaluate these feasibility constructs using mixed methodology: acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited-efficacy. We compare two arms (intervention vs. enhanced standard of care) to determine size of effect rates on contraception initiation. We gather data to inform a future study to evaluate individual components and identify the most parsimonious combination of active components using an adaptive design. We expect these data to inform a trial with adequate sample to evaluate efficacy among contraceptive subtypes and to identify characteristics that enhance or inhibit contraception use. This project is significant because the national burden of adolescent childbearing ($9.4 billion for one year alone) is so great, even a small reduction in incidence should lead to significant cost reductions and reduce generational cycles of poverty and poor health outcomes.

项目摘要尽管怀孕率下降，但美国青少年意外怀孕的负担还是很大的最近几年。尽管存在高效的避孕方法，但青少年面临多层障碍避孕访问和使用。专注于增加青少年避孕启动的研究是至关重要的。急诊室（ED）是一个非传统环境，可以很好地提供生殖护理，因为近1900万青少年每年都在寻求护理，许多人都可以接受在这种情况下接受护理，ED通常是与医疗保健系统的唯一或主要接触最高风险的青年。我们为ED环境提出了一种新颖的避孕咨询干预措施患者，提供商和系统级别的障碍。以先前的工作为基础，并借鉴了传统环境中的策略，我们将培训ED高级实践护士，以提供利用的咨询激励性访谈策略，以促进基于ED的避孕或诊所转诊 15-18岁的性活跃女性。我们将进行一项小型随机试验以评估这些可行性使用混合方法的结构：可接受性，需求，实施，实用性，适应性，集成，扩展和有限效率。我们比较两个臂（干预与增强的标准护理）确定避孕开始的效果率的大小。我们收集数据以告知未来的研究评估单个组件，并使用使用一种自适应设计。我们希望这些数据能够为试验提供足够的样本，以评估避孕子类型并确定增强或抑制避孕使用的特征。这个项目是意义重大，因为青少年育儿负担（仅一年仅94亿美元）是如此之大，即使发病率的少量降低也会导致大幅降低成本并减少世代周期贫穷和健康状况不佳。