在两个大容量的城市产科医院中,按种族、保险和护理地点对妊娠意向进行不公平筛查。

IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Journal of women's health Pub Date : 2025-04-01 Epub Date: 2025-02-11 DOI:10.1089/jwh.2024.0859
Alice Abernathy, Miatta Goba, Markolline Forkpa, Jesse Chittams, Sunni L Mumford, Sindhu K Srinivas, Courtney A Schreiber
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引用次数: 0

摘要

背景:在美国,公共卫生工作的重点是减少意外怀孕。然而,不同种族的意外怀孕、流产和意外分娩率的差异是由患者、卫生系统和提供者相关因素共同驱动的。尽管这种复杂的支架支撑着怀孕意图,但当患者的妊娠试验呈阳性时,他们通常会接受怀孕意图或计划的筛查。我们假设筛查可能因患者和卫生系统特征而异。目的:确定患者和卫生系统特征与接受妊娠意向或计划筛查之间的关系。研究设计:我们对2019年在费城两家医院进行的所有单胎分娩的回顾性队列研究进行了二次分析。我们的主要结果是临床团队是否进行了妊娠意向筛查。我们使用逻辑回归来确定与妊娠意向筛查相关的患者和医院特征。结果:我们确定了9672例分娩,其中48%为黑人,91%为非西班牙裔,45%有公共保险或没有保险;在所有分娩中,33%的人接受了怀孕意图或计划的筛查。如果患者是黑人(2.38[2.10-2.750])或公共保险或未保险(2.78[2.43-3.20]),则更有可能被问及是否有意怀孕。患者接受治疗的医院地点是患者是否被问及妊娠意向的主要驱动因素(10.59[9.35-12.0])。在考虑到医院地点后,黑人患者比白人患者更有可能接受筛查。结论:妊娠意向或计划筛查的不公平是由机构实践和患者种族的差异驱动的。这些发现强调了公平筛查实践的必要性,以确保所有患者获得高质量、公正和以患者为中心的生殖保健。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inequitable Screening for Pregnancy Intention by Race, Insurance, and Site of Care in Two High-Volume Urban Obstetric Hospitals.

Background: In the United States, public health efforts are focused on reducing unintended pregnancy. Yet, differences in rates of unintended pregnancy, abortion, and unintended births by race are driven by a combination of patient-, health system-, and provider-related factors. Despite this complicated scaffolding underpinning pregnancy intention, patients are often screened for pregnancy intention or planning when they have a positive pregnancy test. We hypothesized screening may vary by patient and health system characteristics. Objective: To identify associations between patient and health system characteristics and receiving screening for pregnancy intention or planning. Study Design: We performed a secondary analysis of a retrospective cohort study of all singleton deliveries in 2019 at two Philadelphia hospitals. Our primary outcome was the presence or absence of pregnancy intention screening by the clinical team. We used logistic regression to determine patient and hospital characteristics associated with screening for pregnancy intention. Results: We identified 9,672 deliveries, 48% of births were among Black individuals, 91% were non-Hispanic, and 45% had public or no insurance; of all births, 33% were screened for pregnancy intention or planning. Patients were more likely to be asked if their pregnancy was intended if they were: Black (2.38 [2.10-2.750]) or publicly insured or uninsured (2.78 [2.43-3.20]). The hospital site where the patient received care was the primary driver of whether a patient was asked about pregnancy intention (10.59 [9.35-12.0]). After accounting for the hospital sites, patients of Black race remained significantly more likely to be screened than White patients. Conclusions: Inequities in pregnancy intention or planning screening were driven by differences in institutional practices and patient race. These findings underscore the need for equitable screening practices that ensure all patients receive high-quality, unbiased, and patient-centered reproductive care.

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来源期刊
Journal of women's health
Journal of women's health 医学-妇产科学
CiteScore
6.60
自引率
5.70%
发文量
197
审稿时长
2 months
期刊介绍: Journal of Women''s Health is the primary source of information for meeting the challenges of providing optimal health care for women throughout their lifespan. The Journal delivers cutting-edge advancements in diagnostic procedures, therapeutic protocols for the management of diseases, and innovative research in gender-based biology that impacts patient care and treatment. Journal of Women’s Health coverage includes: -Internal Medicine Endocrinology- Cardiology- Oncology- Obstetrics/Gynecology- Urogynecology- Psychiatry- Neurology- Nutrition- Sex-Based Biology- Complementary Medicine- Sports Medicine- Surgery- Medical Education- Public Policy.
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