Med Ther Med Reprod Gynecol Endocrinol

Objective.The objective of this study is to estimate consumers\u2019 maximum willingness-to-pay (WTP) for follow-up PID services by physicians and community health nurses (CHNs), differences by consumer type (adolescents versus parents), and the differences in health-provider predicted WTP consumer estimates and actual consumer WTP estimates.Methods.In this IRB-approved study, a contingent valuation method was used to collect WTP data regarding co-payments to physicians or nurses for clinical service delivery from the consumers of adolescent PID services (parents and adolescents) and health providers using a national convenience sample. Consumers were recruited from an academic pediatric and adolescent medicine clinic and five health department school-based health clinics in a large urban community with high (sexually transmitted infection) STI prevalence. Participants completed a web-based survey. Data were analyzed using linear regression analyses.Results.Adolescents were willing to pay $36 more (95$27.9\u201344.3) for community health nursing care and parents were willing to pay $48 more dollars (95$40.3-57.4) than physician\u2019s predicted. There were no significant differences in adolescent and parents WTP for physician or nursing services Consumers (adolescents & parents) WTP for physician PID services were on average 18.50 higher than CHN PID services (p = 0.01). Using physician estimates for WTP as the reference group, adolescents were willing to pay $56 more (95$48.6-$63.4) for physician care and parents were willing to pay$66 more (95 % Cl : $59.0-$72.8) than physician\u2019s predicted.Conclusion.Adolescents and parents are willing to pay more for physician follow-up for PID, but they are open to CHN follow-up visits based on the mean WTP for CHN visits. Since WTP also reflects the value that individuals place on a service, our data demonstrate that providers consistently underestimate the value consumers place on clinical services for x adolescents with PID.K01 DP001128/DP/NCCDPHP CDC HHS/United StatesP20 MD000198/MD/NIMHD NIH HHS/United StatesR01 NR013507/NR/NINR NIH HHS/United States2019-05-22T00:00:00Z31131365PMC6530924636

J Pediatr Adolesc Gynecol

Study Objective:To compare clinician perspectives for the treatment of pelvic inflammatory disease (PID) with those of adolescent patients and parents.Design:Cross-sectional study.Setting:Urban academic pediatric and adolescent medicine practices and school-based health clinics in a large urban community with a high prevalence of sexually transmitted infections (STI) and a national sample of adolescent-serving clinicians.Participants:Female patients aged 12\u201319, parents raising an adolescent over the age of 12 in the urban community, and clinicians who serve adolescents collected from regional and national listservs.Interventions:None.Main Outcome Measures:Visual analog scale (VAS) scores on a scale of 0 to 10 corresponding to preferences on patient disposition in 17 clinical scenarios for a hypothetical patient with PID.Results:Compared to adolescents, clinicians were significantly more likely to endorse hospitalizations when patients presented with severe or complicated illness (0.9, SE 0.22, p<0.001), possible surgical emergency (0.83, SE 0.2, p<0.001), concurrent pregnancy (0.59, SE 0.3, p=0.046), or failure of outpatient treatment (0.58, SE 0.29, p=0.045). Compared to clinicians, adolescents were significantly more likely to endorse hospitalizations when patients presented at a young age (1.36, SE 0.38, p<0.001), were homeless (0.88, SE 0.32, p=0.007), were afraid to inform a partner (1.66, SE 0.40, p<0.001), or had unaware parents (2.86, SE 0.39, p<0.001).Conclusion:Clinicians were more likely to recommend hospitalization when doing so adhered to national guidelines on PID treatment. Adolescents opted for hospitalization more often than clinicians in scenarios where patients exhibited social vulnerability. Clinicians should engage with adolescents in shared disposition planning and use a more nuanced approach to PID management for adolescents who may not be able to tolerate an outpatient regimen.K01 DP001128/DP/NCCDPHP CDC HHS/United StatesP20 MD000198/MD/NIMHD NIH HHS/United StatesR01 NR013507/NR/NINR NIH HHS/United States2020-08-01T00:00:00Z30974212PMC67425378081vault:3578

Increasing Asymptomatic Chlamydia Screening in the ED

The Centers for Disease Control and Prevention (CDC) recommends chlamydia screening in young women and others who are at risk based on scientific evidence related to the effectiveness of screening to prevent chlamydial infection. Female patients may visit the emergency department (ED) with symptoms such as urethritis, abdominal pain, or vaginal spotting. For men, most complaints are urinary problems, discharge from the penis, and testicular pain. However, most infected patients are never symptomatic and have no abnormal physical findings. Therefore, the question that spurred this project was, “Why aren’t asymptomatic patients screened more often?” Furthermore, “Why are the CDC screening guidelines for chlamydia often not followed by providers?” The purpose of this evidence-based project was to provide an educational intervention to health care providers in the Emergency Department (ED) about the CDC guidelines for chlamydia screening and to encourage them to screen eligible asymptomatic patients in a Bronx community-based ED. As a result of the educational intervention, there was a significant improvement of the ED providers’ knowledge of the CDC guidelines; however, the screening rate remained low. During the period after the educational intervention, the ED participants did not satisfactorily comply with the CDC guidelines; however, ED participants consistently demonstrated their willingness to perform the chlamydia screening for eligible patients. This finding indicates a need for frequent education on the CDC guidelines on the importance of chlamydia testing to effectively improve the screening rates

Quality of Health Care for Children and Adolescents: A Chartbook

Contains 40 charts and analyses that represent the current state of pediatric health care. Provides practical guidance and recommendations for policymakers, health care professionals, and patient advocates

Bridging the Divide White Paper: Long-Acting Reversible Contraception (LARC) in the United States

Long-acting reversible contraceptive (LARC) methods – specifically, intrauterine devices (IUDs) and subcutaneous hormone-releasing implants – demonstrate great potential in reducing unintended pregnancy. Although LARC methods have had a rocky history in the US and use rates have remained low here in comparison to other countries where the methods are available, there has been a significant increase in uptake of newer LARC products in recent years. Researchers have identified this change as a likely contributor to the declines seen in unintended pregnancy, abortion, and teen pregnancy rates. Decades of research have shown that current LARC methods are highly safe and effective, yet research has identified many barriers that may prevent a woman who chooses a LARC as the contraceptive method that best meets her needs and preferences from getting it. These include inadequate provider knowledge and training, lack of awareness and education among potential users, and financial and health system barriers. There are also, however, encouraging research findings from assessments of interventions designed to reduce these barriers. Despite the recent advances, some barriers to full, voluntary, and successful use of LARC methods remain but have the potential to be addressed through policy: implementation of insurance coverage for LARC insertion and removal, both under private plans and public programs, such as Medicaid; development of clinical performance measures for clinicians and/or health centers; and establishment of practices that ensure confidentiality and non-coercive provision of LARC methods, particularly for vulnerable populations

An Approach to Discuss Preconception Care to Childbearing Women in Primary Care Practice

Abstract Background: To examine the effects of implementing patient education on preconception care to all women including women of reproductive age. This quality improvement (QI) project was formed with evidence-based research that provides awareness to women on their fertility and conception, and to become their advocates to their reproductive health. Purpose: The purpose of the study is to improve the quality of reproductive health for young women of childbearing age and to educate women on preconception care and fertility awareness. Methods: Recruitment were chosen at random until the goal of 20 participants were obtained. Participants were directed to use a tablet device or phone to complete the pretest and posttest via QR code or web link. Frequency counts were used to examine the distribution of categorical demographic variables to determine the appropriate statistical test to report knowledge about preconception care. Parametric statistics were determined to be most appropriate due to the nature of the data and distribution of scores. Specifically, the Wilcoxon Signed Rank test was used to examine whether the change in knowledge was statistically significant. Frequency distributions were also used to report the distribution of responses on additional items asked at the posttest. Results: At the pretest, scores ranged from 4 to 7 with a mean of 6.65 (SD = 0.75). At the posttest, scores ranged from 5 to 7 with a mean of 6.5 (SD = 0.71). 20 participants were recruited with 50% attrition rate as not all had completed the post-test individually from the same tablet or device. Analysis of the 10 cases with matched data from pre- and post- revealed that knowledge did not change significantly from pre- to post- (p = 1.00). Despite the fact that the P value was not statistically significant change in knowledge, when asked whether they believed they learned more about preconception health after viewing the PowerPoint, 100% of the women said yes. Conclusions: Preconception care is important for all women including women of childbearing age but results reveal it may not be discussed to each woman in primary care practice. It is important for women to become more empowered to talk about their reproductive and pregnancy plans with their PCP. For providers, cultural and familial influences should be considered and taken into account for each individual

Beliefs About Dysmenorrhea and Their Relationship to Self‐Management

Dysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self‐management of dysmenorrhea is not well understood in the US, and little evidence is available on factors that influence dysmenorrhea self‐management. Guided by the Common Sense Model, we examined women's representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self‐management behaviors, and investigated the relationship between representations and self‐management behaviors. We conducted a cross‐sectional, web‐based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants had varied beliefs about the causes of their dysmenorrhea symptoms, which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well and perceived them as moderately controllable but them to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care‐seeking and use of self‐management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self‐management interventions that address dysmenorrhea representations and facilitate evidence‐based management

Confidentiality, insurance, and provider-based barriers to sexual and reproductive health services

This dissertation consists of three studies that examine barriers to sexual and reproductive health care among commercially insured young adults and women. Study 1 investigates differences in insurance use behavior for confidential SRH care by young adults with parental versus policyholder coverage. Findings demonstrate that individuals with parental insurance coverage are less likely than their counterparts with policyholder coverage to use their insurance to pay for pap testing, contraception, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Study 2 builds on this work to evaluate the role of the national dependent coverage expansion on insurance use for sexual and reproductive health services. Findings demonstrate an aggregate reduction in insurance use for pap testing, contraception, and STI testing among young adult women newly eligible for parental coverage under the expansion. Study 3 examines prevalence and trends in non-indicated pelvic examinations performed during contraceptive visits, along with variations by provider specialty and patient age. Results show a substantial increase in the number of pelvic examinations performed during contraceptive encounters from 2007 – 2017, and higher rates of non-indicated exams performed by obstetrician-gynecologists. Together, this research provides evidence of barriers to sexual and reproductive health care among commercially insured young adults and women, highlighting ongoing issues of patient privacy and autonomy in health care financing and service delivery.2022-05-14T00:00:00