Provision of sexual health services to adolescent enrollees in Medicaid managed care.
OBJECTIVES: This Seattle project measured sexual health services provided to 1112 Medicaid managed care enrollees aged 14 to 18 years. METHODS: Three health maintenance organizations (HMOs) that provide Medicaid services for a capitated rate agreed to participate. These included a non-profit staff-model HMO, a for-profit independent practice association (IPA), and a non-profit alliance of community clinics. Analyses used health maintenance organizations' administrative data, chart reviews, and Medicaid encounter data. RESULTS: Health maintenance organizations provided primary care to 54% and well care to 20% of Medicaid enrollees. Girls were more likely than boys to have their sexual history taken or to be given condom counseling. Only 27% of sexually active girls were tested for chlamydia, with significantly lower rates of testing among those who spoke English as a second language. The nonprofit staff-model plan outperformed the for-profit independent practice association on most measures. CONCLUSIONS: Substantial room for improvement exists in sexual health services delivery to adolescent Medicaid managed care enrollees. (+info)
A 6-month pilot of a collaborative clinic between genitourinary medicine services and a young persons' sexual health clinic.
OBJECTIVE: To investigate whether situating a genitourinary medicine (GUM) clinic within a Brook centre is successful in attracting a younger client group than that traditionally seen in GUM clinics within hospitals. DESIGN: A descriptive study of a 6-month pilot clinic. SETTING: Brook in Manchester. A community clinic providing sexual health advice to clients under the age of 25 years. With the collaboration of Withington Hospital GUM Department, Manchester. PARTICIPANTS: All clients under the age of 25 years attending the pilot GUM clinic. MAIN OUTCOME MEASURES: The age of the clients attending and the diagnosis made. RESULTS: A total of 137 visits were made by 93 clients. Under-16s comprised 6% of all visits compared to 1.5% at Withington GUM clinic (adjusted for the under-25s) and 12% at Brook. Far more Chlamydia trachomatis was seen (34% of all clients) than in a traditional GUM clinic (18% of all clients). Contact tracing resulted in 82% of named contacts being traced. CONCLUSION: The pilot clinic was successful in attracting a much younger client group than a traditional hospital-based service. (+info)
Comparing the quality of three models of postabortion care in public hospitals in Mexico City.
CONTEXT: Each year, an estimated 120,000 women in Mexico seek treatment in public hospitals for abortion-related complications--the country's fourth leading cause of maternal mortality. Models of postabortion care emphasizing counseling and provision of contraceptives have the potential to improve the quality of care these women receive. METHODS: Between April 1997 and August 1998, women treated for abortion complications in six Mexican Institute of Social Security (IMSS) hospitals in the Mexico City metropolitan area were surveyed. Data related to patient-provider interaction, information provision and counseling were analyzed for three models of care: sharp curettage standard care, sharp curettage postabortion care and manual vacuum aspiration postabortion care. RESULTS: Women in the two postabortion care groups rated the quality of services they received more highly than did those receiving sharp curettage standard care. A significantly greater proportion of women treated under the postabortion care models than of those treated under the sharp curettage standard model received information about their health status before treatment, the uterine evacuation procedure, signs of postabortion complications and care at home. In addition, a greater proportion of women treated under the postabortion care models accepted a contraceptive method before leaving the facility (64-78% vs. 40%). CONCLUSIONS: Implementation of a postabortion care model contributes to the delivery of high-quality services to women experiencing abortion complications. The standard IMSS model of postabortion treatment should be modified to emulate those in hospitals that systematically link general counseling and family planning services to the clinical services provided to women with abortion complications. (+info)
Facility-level reproductive health interventions and contraceptive use in Uganda.
CONTEXT: In Uganda, modern contraceptive use has recently increased in areas served by the Delivery of Improved Services for Health (DISH) project. Whether these increases are associated with facility-level factors is unknown, however. METHODS: Data from the 1999 DISH Evaluation Surveys were used in multivariate logistic regressions to assess the independent relationships of five indicators of the family planning service environment with individual-level use of a modern contraceptive in rural and urban areas. The surveys consisted of a household questionnaire of 1,766 women of reproductive age and a facility module implemented in all health facilities that serve the sampled population. RESULTS: After women's social and demographic characteristics were controlled for, none of the service environment factors was independently associated with current use of a modern method in rural areas. By contrast, in urban areas, the proximity of a private health facility (which likely reflects an increased availability of methods) was positively associated with current use (odds ratio, 2.1), as was the presence of a higher number (three or more) of DISH-trained service providers (1.7). CONCLUSIONS: The presence of private health facilities was the factor most strongly associated with contraceptive use in urban areas, perhaps because they improved the availability of methods. Few other facility-level program inputs had significant effects. (+info)
Contextual influences on reproductive wellness in northern India.
OBJECTIVES: There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. METHODS: Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. RESULTS: The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. CONCLUSIONS: Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes. (+info)
FFPRHC Guidance (October 2003): First prescription of combined oral contraception.
The Guidance provides information for clinicians on the steps to be taken before providing a woman with her first prescription for combined oral contraception. It updates and replaces previous Faculty Guidance. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance, and evidence tables summarising the research basis of the recommendations, are available on the Faculty website (www.ffprhc.org.uk). Abbreviations used include: blood pressure (BP), body mass (BMI), bone mineral density (BMD), breakthrough bleeding (BTB), British National Formulary (BNF), combined oral contraception (COC), Committee on Safety of Medicines (CSM), confidence interval (CI), deep vein thrombosis (DVT), emergency contraception (EC), ethinyl oestradiol (EE), Faculty Aid to Continuing Professional Development Topics (FACT), Family Planning Association (fpa), follicule-stimulating homone (FSH), general practitioner (GP), intermenstrual bleeding (IMB), luteinising hormone (LT), microgram, myocardial infarction (MI), odds ratio (OR), oral contraception (OC), pulmonary embolism (PE), relative risk (RR), Scottish Intercollegiate Guideline Network (SIGN), sexually transmitted infection (STI), Summary of Product Characteristics (SPCs), venous thomboembolism (VTE), World Health Organization (WHO), WHO Medical Eligibility Criteria (WHOMEC), WHO Selected Practice Recommendations (WHOSPR). (+info)
The psychosocial context of young adult sexual behavior in Nicaragua: looking through the gender lens.
CONTEXT: Understanding the nature and magnitude of gender differences in sexual norms among young adults in Nicaragua, and how these differences affect sexual behavior, is important for the design of reproductive health programs. METHODS: A representative cross-sectional survey was conducted in six departments in the Pacific region of Nicaragua in 1998. A total of 552 never-married women and 289 never-married men aged 15-24 were interviewed about their perceptions of social pressure to engage in premarital sex; perceived social approval of and attitudes toward premarital sex and premarital pregnancy; perceived sexual activity among peers and siblings; communication with parents on sexuality issues; the psychosocial context of sexual debut; and preferred sources of information on sexuality issues. RESULTS: Most young men (83%) reported that they had received direct encouragement from at least one person in the last year to engage in premarital sex, and at least half perceived that their father, siblings, other relatives and friends approved of premarital intercourse. A significantly greater proportion of men than of women reported that curiosity or gaining experience motivated their sexual debut (61% vs. 21%). Men perceived themselves to have a higher risk of unplanned and unprotected sex than did women. In contrast, women held more negative attitudes toward premarital sex and were more often discouraged by parents or siblings from engaging in sex. CONCLUSIONS: Reproductive health programs for young Nicaraguans need to address gender-based double standards, which raise the risk of unplanned, unprotected sex and unintended pregnancy. (+info)
Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles.
A multi-center study was performed in Brazil, Chile, and Mexico to identify factors that may facilitate or hinder the introduction of emergency contraception (EC) as well as perceptions concerning emergency contraceptive pills. Background information on the socio-cultural, political, and legal context and the characteristics of reproductive health services was collected. The opinions of potential users and providers were obtained through discussion groups, and those of authorities and policymakers through semi-structured interviews. Barriers to introduction included: perception of EC as an abortifacient, opposition by the Catholic Church, limited recognition of sexual and reproductive rights, limited sex education, and insensitivity to gender issues. Facilitating factors were: perception of EC as a method that would prevent abortion and pregnancy among adolescents and rape victims; interest in the method shown by potential users as well as by some providers and authorities. It appears possible to reduce barriers through support from segments of society committed to improving sexual and reproductive health and adequate training of health care providers. (+info)