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Patient-, Provider- and System-level Factors Impacting Contraceptive Access and Use
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| 자료유형 | 학위논문 |
|---|---|
| 서명/저자사항 | Patient-, Provider- and System-level Factors Impacting Contraceptive Access and Use. |
| 개인저자 | Judge-Golden, Colleen Patricia. |
| 단체저자명 | University of Pittsburgh. School of Medicine. |
| 발행사항 | [S.l.]: University of Pittsburgh., 2019. |
| 발행사항 | Ann Arbor: ProQuest Dissertations & Theses, 2019. |
| 형태사항 | 123 p. |
| 기본자료 저록 | Dissertations Abstracts International 81-04B. Dissertation Abstract International |
| ISBN | 9781088374566 |
| 학위논문주기 | Thesis (Ph.D.)--University of Pittsburgh, 2019. |
| 일반주기 |
Source: Dissertations Abstracts International, Volume: 81-04, Section: B.
Advisor: Borrero, Sonya |
| 이용제한사항 | This item must not be sold to any third party vendors.This item must not be added to any third party search indexes. |
| 요약 | Contraception plays vital roles in promoting women's health, quality of life and reproductive autonomy. The research described in this dissertation aimed to identify and evaluate factors at the patient, provider, and system levels that contribute to individuals' abilities to access and use contraceptive methods in concordance with their goals and preferences. We assessed contraceptive preference matching and evaluated system-level policies and provider practices that directly impact access to specific methods, with a particular focus on the medically vulnerable population of women Veterans who use the Veterans Affairs (VA) healthcare system.First, we used a novel measure to investigate the extent to which women Veterans are currently using the contraceptive methods they consider to be "ideal," and identified characteristics associated with ideal-current method match. Only 58% were currently using their stated ideal method, and match was reduced among non-white women and women with mental health disorders, suggestive of established health care disparities. However, qualitative analysis revealed that the bulk of reasons for ideal method non-use were personal and contextual, rather than resulting from access barriers. Our results underscore the complexity of contraceptive method selection and highlight enduring methodologic challenges of measuring contraceptive preferences.Next, we used decision analysis to estimate financial and reproductive health impacts to the VA healthcare system of a policy change to allow for twelve-month dispensing of oral contraceptive pills. We found that extended dispensing would better enable women Veterans to prevent unintended pregnancies, while also being economically feasible and sustainable for VA. These findings may help to inform evidence-based policy in VA.Finally, we conducted a cross-sectional survey study to evaluate provider-level adherence to best practice guidelines for provision of long-acting reversible contraception (LARC, i.e. intrauterine devices and contraceptive implants) in a single large healthcare system in Western Pennsylvania. We found substantial room for improvement in adherence to best practices, particularly same-day provision of these methods, and identified provider-reported barriers to best practice implementation, which were primarily logistical rather than stemming from knowledge deficits. These results may be used to inform efforts to expand access to LARC methods across this healthcare system. |
| 일반주제명 | Health sciences. Medicine. Public health. |
| 언어 | 영어 |
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: 이 자료의 원문은 한국교육학술정보원에서 제공합니다. |
