RESUMO
BACKGROUND: The FDA approval of mifepristone in 2000 broadened the available options for abortion. The aim of this study was to evaluate whether physicians in New Mexico have integrated the use of mifepristone into their practice. STUDY DESIGN: We performed a mail-out survey of New Mexico Obstetrician Gynecologists (Ob-Gyn) and Family Medicine (FM) physicians in 2001 and 2008. Questions addressed integration of abortion services, attitudes towards providing abortion in different scenarios and barriers to offering abortion services. RESULTS: The response rates were 59% for the 2001 survey and 54% in 2008. In 2001 and 2008, 11% and 15% (p=.26) of physicians, respectively, provided any abortion - medical or surgical. Similarly, in 2001 and 2008, 5% and 10% (p=.07) provided medical abortion. Commonly cited barriers to provision of abortion in both years were beliefs against abortion and lack of training. CONCLUSIONS: The number of physicians offering any abortion or medical abortion in New Mexico has not changed since the FDA approval of mifepristone. Residency training programs in FM and in Ob-gyn should include training in medical abortion.
Assuntos
Abortivos Esteroides/provisão & distribuição , Aborto Induzido/estatística & dados numéricos , Mifepristona/provisão & distribuição , Aborto Induzido/métodos , Aborto Induzido/psicologia , Atitude do Pessoal de Saúde , Medicina de Família e Comunidade/estatística & dados numéricos , Medicina de Família e Comunidade/tendências , Feminino , Ginecologia/estatística & dados numéricos , Ginecologia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico , Obstetrícia/estatística & dados numéricos , Obstetrícia/tendências , Padrões de Prática Médica , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: New Mexico enacted a law in 2003 requiring that emergency departments (EDs) offer emergency contraception (EC) to survivors of sexual assault and that both doses be administered in the ED. This investigation sought to examine practices and knowledge of ED providers about EC in the setting of sexual assault. METHODS: We visited hospitals in New Mexico from July 2005 to December 2005 and administered an 18-item questionnaire to three providers-a physician, a nurse, and a clerk-in the ED. The questionnaire included items related to characteristics of the hospital, knowledge of providers about EC and the law, and ED practices relevant to EC for sexual assault survivors as well as for women who had consensual unprotected intercourse. RESULTS: Surveys were completed at 33 of 38 hospitals (87%). Overall, 52% of respondents reported that EC was routinely offered to sexual assault survivors, and 33% reported that both doses were administered in the ED. Forty-one percent of RNs, MDs, and clerks reported that EC was offered to sexual assault survivors who were minors regardless of age. Overall, 64% of respondents knew that EC may prevent pregnancy up to 72 hours after unprotected intercourse, and only 12% of respondents reported awareness of any requirements to offer EC to sexual assault survivors. Respondents reported that physicians in the ED more often routinely offered EC to sexual assault survivors (52%) than to women who requested it after consensual sex (20%). Thirty-three percent of respondents indicated parental consent was necessary for minors in the setting of sexual assault, although there is no requirement for parental notification in New Mexico. CONCLUSIONS: EDs in New Mexico are not universally complying with the law. Better dissemination of the law and education about EC could improve care of sexual assault survivors in New Mexico.
Assuntos
Anticoncepção Pós-Coito/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos em Hospital/estatística & dados numéricos , Relações Profissional-Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Aconselhamento/estatística & dados numéricos , Serviço Hospitalar de Emergência/legislação & jurisprudência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Recursos Humanos em Hospital/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde , Sobreviventes/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: National and international contraceptive guidelines reflect expert opinion that recommends against the use of estrogen-containing hormonal contraception in the early postpartum period. This study was undertaken to estimate providers' practices in prescribing hormonal contraception to breastfeeding women. METHODS: A 19-item survey was mailed to 397 obstetrician gynecologists, midwives and family physicians in the state of New Mexico. The survey included items covering attitudes about the impact of hormonal contraception on breastfeeding and prescribing practices. One hundred ninety-nine (50%) providers completed the survey. RESULTS: The majority (70%) of providers prescribe progestin-only contraceptive methods to breastfeeding women within the first 6 weeks. Despite these recommendations, a sizable minority of providers prescribe combined pills in the early postpartum period: 27% of providers have prescribed combined pills and 13% of providers, mostly those in a university setting, routinely recommend them within the first 6 weeks postpartum. CONCLUSION: Most providers follow expert recommendations regarding the initiation of hormonal contraception for breastfeeding women.