紧急、急诊还是错过？美国急诊科在处理早孕损失方面的地缘政治差异

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2024-10-07 DOI:10.1016/j.contraception.2024.110626

ED Lantos, LS Benson, R Sangara, P Garza, M Pearlman Shapiro, BT Nguyen

{"title":"紧急、急诊还是错过？美国急诊科在处理早孕损失方面的地缘政治差异","authors":"ED Lantos, LS Benson, R Sangara, P Garza, M Pearlman Shapiro, BT Nguyen","doi":"10.1016/j.contraception.2024.110626","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe geopolitical variations in Emergency Medicine (EM) providers’ treatment of early pregnancy loss (EPL) and evaluated their attitudes toward directly managing EPL, with attention to the influence of post-<em>Dobbs v Jackson Women’s Health Organization</em> restrictions.</div></div><div><h3>Methods</h3><div>We distributed a nationwide anonymous survey to emergency medicine clinicians using specialty-specific listservs and social media platforms, exploring experience and comfort with EPL diagnosis and management, as well as relevant institutional and structural barriers, inclusive of state abortion restrictions. We examined associations between state restrictions and emergency medicine resources via bivariate analysis.</div></div><div><h3>Results</h3><div>Most participants (n=203) identified as female (56.6%), non-Hispanic White (69.0%), attendings (73.6%), in urban settings (82.7%) and abortion-permissive states (60.8%). Most reported comfort diagnosing (93.0%) and counseling (86%) about EPL. However, only 39.7% consistently counseled on all management options--expectant, medication, procedural. Participants in abortion-permissive states were significantly more likely to consistently offer comprehensive counseling (44.2% vs. 32.7%, p=0.02) and reported increased access to on-site Ob-Gyn consultation (49.6% vs. 27.5%, p=0.002). Regardless of restrictions, only 16.2% consistently prescribed mifepristone-misoprostol; fewer (3.5%) performed manual uterine aspiration. 49.7% felt stable patients experiencing EPL should not receive treatment in the ED; 48.7% felt Ob-Gyns should manage EPL; 44.0% reported that arranging follow-up was a barrier to management. The majority (78.1%) endorsed the importance of more training on medication management of EPL.</div></div><div><h3>Conclusions</h3><div>Less than 20% of emergency medicine clinicians consistently offer EPL treatment. On-site Ob-Gyn consultations remain an essential resource, though less accessible in abortion-restrictive states. Training emergency medicine providers to treat EPL and improving access to follow-up could improve care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"URGENT, EMERGENT, OR JUST MISSED? GEOPOLITICAL VARIATIONS IN THE MANAGEMENT OF EARLY PREGNANCY LOSS IN US EMERGENCY DEPARTMENTS\",\"authors\":\"ED Lantos, LS Benson, R Sangara, P Garza, M Pearlman Shapiro, BT Nguyen\",\"doi\":\"10.1016/j.contraception.2024.110626\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>We aimed to describe geopolitical variations in Emergency Medicine (EM) providers’ treatment of early pregnancy loss (EPL) and evaluated their attitudes toward directly managing EPL, with attention to the influence of post-<em>Dobbs v Jackson Women’s Health Organization</em> restrictions.</div></div><div><h3>Methods</h3><div>We distributed a nationwide anonymous survey to emergency medicine clinicians using specialty-specific listservs and social media platforms, exploring experience and comfort with EPL diagnosis and management, as well as relevant institutional and structural barriers, inclusive of state abortion restrictions. We examined associations between state restrictions and emergency medicine resources via bivariate analysis.</div></div><div><h3>Results</h3><div>Most participants (n=203) identified as female (56.6%), non-Hispanic White (69.0%), attendings (73.6%), in urban settings (82.7%) and abortion-permissive states (60.8%). Most reported comfort diagnosing (93.0%) and counseling (86%) about EPL. However, only 39.7% consistently counseled on all management options--expectant, medication, procedural. Participants in abortion-permissive states were significantly more likely to consistently offer comprehensive counseling (44.2% vs. 32.7%, p=0.02) and reported increased access to on-site Ob-Gyn consultation (49.6% vs. 27.5%, p=0.002). Regardless of restrictions, only 16.2% consistently prescribed mifepristone-misoprostol; fewer (3.5%) performed manual uterine aspiration. 49.7% felt stable patients experiencing EPL should not receive treatment in the ED; 48.7% felt Ob-Gyns should manage EPL; 44.0% reported that arranging follow-up was a barrier to management. The majority (78.1%) endorsed the importance of more training on medication management of EPL.</div></div><div><h3>Conclusions</h3><div>Less than 20% of emergency medicine clinicians consistently offer EPL treatment. On-site Ob-Gyn consultations remain an essential resource, though less accessible in abortion-restrictive states. Training emergency medicine providers to treat EPL and improving access to follow-up could improve care.</div></div>\",\"PeriodicalId\":10762,\"journal\":{\"name\":\"Contraception\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Contraception\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0010782424003214\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Contraception","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0010782424003214","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

方法我们通过特定专业的列表服务器和社交媒体平台向急诊科临床医生分发了一份全国范围的匿名调查，调查内容包括对早孕损失（EPL）诊断和管理的经验和舒适度，以及相关的制度和结构性障碍，包括各州的堕胎限制。我们通过双变量分析研究了州限制与急诊医学资源之间的关联。结果大多数参与者（n=203）认为自己是女性（56.6%）、非西班牙裔白人（69.0%）、主治医师（73.6%）、城市环境（82.7%）和允许堕胎的州（60.8%）。大多数人表示对 EPL 的诊断（93.0%）和咨询（86%）感到满意。然而，只有 39.7% 的人始终如一地就所有处理方案提供咨询，包括期待治疗、药物治疗和手术治疗。允许堕胎州的参与者更有可能持续提供全面咨询（44.2% 对 32.7%，P=0.02），并报告有更多机会获得现场妇产科咨询（49.6% 对 27.5%，P=0.002）。无论限制条件如何，只有 16.2% 的人坚持处方米非司酮-米索前列醇；较少的人（3.5%）进行了人工子宫吸引术。49.7%的人认为病情稳定的宫缩患者不应在急诊室接受治疗；48.7%的人认为妇产科医生应处理宫缩；44.0%的人表示安排随访是处理宫缩的障碍。大多数人（78.1%）都认为必须加强对急诊室急症室药物管理的培训。结论只有不到 20% 的急诊科临床医生持续提供急诊室急症室治疗。尽管在限制堕胎的州，现场妇产科会诊仍是一项重要资源。对急诊医疗服务提供者进行 EPL 治疗培训并改善随访服务可改善医疗服务。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

URGENT, EMERGENT, OR JUST MISSED? GEOPOLITICAL VARIATIONS IN THE MANAGEMENT OF EARLY PREGNANCY LOSS IN US EMERGENCY DEPARTMENTS

Objectives

We aimed to describe geopolitical variations in Emergency Medicine (EM) providers’ treatment of early pregnancy loss (EPL) and evaluated their attitudes toward directly managing EPL, with attention to the influence of post-Dobbs v Jackson Women’s Health Organization restrictions.

Methods

We distributed a nationwide anonymous survey to emergency medicine clinicians using specialty-specific listservs and social media platforms, exploring experience and comfort with EPL diagnosis and management, as well as relevant institutional and structural barriers, inclusive of state abortion restrictions. We examined associations between state restrictions and emergency medicine resources via bivariate analysis.

Results

Most participants (n=203) identified as female (56.6%), non-Hispanic White (69.0%), attendings (73.6%), in urban settings (82.7%) and abortion-permissive states (60.8%). Most reported comfort diagnosing (93.0%) and counseling (86%) about EPL. However, only 39.7% consistently counseled on all management options--expectant, medication, procedural. Participants in abortion-permissive states were significantly more likely to consistently offer comprehensive counseling (44.2% vs. 32.7%, p=0.02) and reported increased access to on-site Ob-Gyn consultation (49.6% vs. 27.5%, p=0.002). Regardless of restrictions, only 16.2% consistently prescribed mifepristone-misoprostol; fewer (3.5%) performed manual uterine aspiration. 49.7% felt stable patients experiencing EPL should not receive treatment in the ED; 48.7% felt Ob-Gyns should manage EPL; 44.0% reported that arranging follow-up was a barrier to management. The majority (78.1%) endorsed the importance of more training on medication management of EPL.

Conclusions

Less than 20% of emergency medicine clinicians consistently offer EPL treatment. On-site Ob-Gyn consultations remain an essential resource, though less accessible in abortion-restrictive states. Training emergency medicine providers to treat EPL and improving access to follow-up could improve care.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.