医院内提供流产后计划生育服务的可行性研究

The feasibility of providing post abortion family planning services in hospital settings

目的：分析在医院内提供流产后计划生育服务的可行性。方法：2011年5~8月采用随机整群抽样方法选取上海市60家医院的596名医生进行调查。结果：医生年龄39.0±7.52岁（24~60岁）,日均门诊量中位数40（10~120）人次,每个流产者诊疗时间中位数15（5~90）min,流产后计划生育咨询时间中位数5（1~30）min。医生对选择流产后避孕方法的知识掌握程度以宫内节育器和紧急避孕最好,口服避孕药、单纯孕激素避孕方法及杀精子剂相对薄弱。虽然61.9%的医生认为为流产妇女提供计划生育咨询是门诊医生的责任,但认为最佳与可行的宣教和咨询方式存在明显差异（P〈0.01）。以下障碍影响了在医院提供流产后计划生育服务,包括门诊工作量太大医生无法保证咨询质量（89.6%）,无专人负责避孕咨询（66%）,无合适场地提供隐私服务（38.8%）,避孕药具种类有限（29.1%）,流产妇女无迫切需求（17.4%）。结论：需加强对医务人员流产后避孕标准操作规程的培训,同时必须从医院支持、管理激励、改善硬件、保障药具供给和人群健康教育多个方面共同努力才能有效提高医院实施流产后计划生育服务的可行性。

Objective： To analyze the feasibility of providing post abortion family planning services in hospital settings in Shanghai. Methods： 596 doctors from 60 hospitals were selected using cluster random sampling, and anonymous ques- tionnaire was used to collect information. Results： The average age of doctors was 39.0 ± 7.52 （24-60）. The median number of patients every day was 40（10-120）. The median time for every abortion patient was 15 minutes （5-90）. The median time for post family planning counselling was 5 minutes （1-30）. Doctorslevel of knowledge about post abortion family planning choice on emergency contraception and intra-uterus device was high, but on oral contraceptives, pro- gesterone only methods and spermicide was limited. Though 61.9 % doctors felt that it＇s their responsibilities to provide post abortion family planning counseling, their perception on the best and the feasible way to provide post abortion family planning advocacy and counseling was different（P〈0.01）. Barriers affecting the provision of post family plan- ning services included that doctors can＇t ensure the quality of counseling because of too much workload （89.6%）, no special personnel took charge of counseling （66 % ）, and no appropriate place to protect patient＇s privacy （38.8 %）, and limited choice of contraceptive at the out-patient clinic （29.1%）, and women didn＇t have urgent needs （17.4 %）. Con- clusion： Health professional training alone is not enough. It＇s possible to increase the feasibility of providing post family planning services in hospital settings including hospital support, performance management, hardware facility improve- ment, ensuring contraceptive supply and population health education.