Abstract:
OBJECTIVE:To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception. METHODS:A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed. RESULTS:Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies. CONCLUSION:Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Rodriguez MI,Hersh A,Anderson LB,Hartung DM,Edelman ABdoi
10.1097/AOG.0000000000003265subject
Has Abstractpub_date
2019-06-01 00:00:00pages
1238-1246issue
6eissn
0029-7844issn
1873-233Xpii
00006250-201906000-00023journal_volume
133pub_type
杂志文章abstract:OBJECTIVE:To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy. METHODS:We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003468
更新日期:2019-10-01 00:00:00
abstract::Studies were conducted in 343 women on the clinical utility of the newly developed tumor-associated mucin-type glycoprotein, CA 54/61, as a tumor marker in serum for ovarian cancer. The overall positivity rate of the new marker was 60%, lower than the rate of 88% obtained with CA 125 measured concurrently. Concerning ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:It has been suggested that Q fever infection in pregnancy is associated with various maternal and neonatal adverse outcomes, including intrauterine growth restriction, stillbirth, preterm delivery, intrauterine fetal death, and oligohydramnios. CASE:We describe the cases of two pregnant women remote from te...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e318260590f
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:To examine the concordance between self-collected and clinician-collected samples for human papillomavirus (HPV) DNA. METHODS:Sexually active adolescent and young adult women aged 14-21 years (N = 101) were enrolled in a prospective cohort study of HPV testing. Participants self-collected vaginal samples for...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000124569.61462.8d
更新日期:2004-05-01 00:00:00
abstract::Electrical accidents during pregnancy are relatively infrequent, and reports are rare. Six pregnant women who suffered an electrical injury during pregnancy are presented here. For all, the current path through the body was from hand to foot. Changes that occurred in fetal movements and development as well as the outc...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198606000-00024
更新日期:1986-06-01 00:00:00
abstract::Thirty-six patients with menorrhagia were treated with a technique for laser destruction of the endometrium in which the end of the fiberoptic guide of the Nd:Yag laser is not allowed to come in contact with the endometrium. The results were excellent in 93.9% of the 33 patients followed over three months. Amenorrhea ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-04-01 00:00:00
abstract:OBJECTIVE:To examine whether maternal meal ingestion affects the fetal circulation in uncomplicated pregnancies. METHODS:A simple crossover blinded study was designed for late uncomplicated singleton pregnancies. After overnight fasting, two different maternal meal states were tested. In one state, pregnant women had ...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0029-7844(97)00281-0
更新日期:1997-09-01 00:00:00
abstract::The relation between clinically obvious polyhydramnios and poor perinatal outcome has been described. Much less is known about mild, unexplained polyhydramnios, which usually is initially suggested by sonographic examination late in gestation. The purpose of the present investigation was to relate mild idiopathic poly...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-199203000-00012
更新日期:1992-03-01 00:00:00
abstract::Cerebral hemodynamics were studied in eight nonpregnant women and 24 women in late pregnancy by internal carotid artery velocimetry with a 3.5-MHz continuous-wave Doppler system. Criteria for supine hypotensive syndrome were a mean blood pressure decrease of 15 mmHg and a 2-minute sustained increase in pulse of 20 bea...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:To examine the availability of trial of labor after cesarean delivery (TOLAC) in New Mexico from 1998 to 2012 and maternity care providers' perception of barriers to TOLAC. METHODS:Hospital maternity unit directors were surveyed regarding TOLAC availability from 1998 to 2012. Maternity care providers (obstet...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31829bd0a0
更新日期:2013-08-01 00:00:00
abstract::Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation, including for those with ruptured membranes and...
journal_title:Obstetrics and gynecology
pub_type: 共识发展会议,杂志文章
doi:10.1097/AOG.0000000000001706
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To assess the neurologic and developmental outcome at 2 years of age in preterm infants with birth weights 600 g or lower. METHOD:We conducted a retrospective review from January 1994 through December 1998 for placental histopathology, maternal factors, neonatal intensive care unit course, growth, neurologic...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(02)02451-1
更新日期:2003-01-01 00:00:00
abstract::Twelve patients with symptomatic septate uteri underwent hysteroscopic division of the uterine septum, monitored by concomitant laparoscopy, over a six-year period. The preoperative reproductive performance included 42 pregnancies, with only three viable deliveries. Ten of the 12 patients conceived within one year aft...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198602000-00017
更新日期:1986-02-01 00:00:00
abstract::Six new cases of idiopathic thrombocytopenic purpura (ITP) associated with pregnancy are reported; one of these patients delivered triplets. In addition, 78 patients with 122 pregnancies and 124 fetuses have been reported previously. The maternal mortality rate was 4% and the fetal mortality rate was 18%. Prior recomm...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-197805000-00018
更新日期:1978-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the anatomy and function of the levator ani in normal women by dynamic magnetic resonance imaging. METHODS:Twelve asymptomatic, nulliparous, premenopausal women with no previous pelvic surgery underwent a dynamic magnetic resonance imaging scan of their pelvis. The origin, orientation, thickness,...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(01)01743-4
更新日期:2002-03-01 00:00:00
abstract::Preoperative abdominopelvic computed tomography results and operative findings were compared in 52 patients undergoing second-look laparotomy to confirm tumor status. Seventeen true-negative, 22 false-negative, and 13 true-positive scans were found. The sensitivity was 0.38, specificity was 1.0, and diagnostic accurac...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-05-01 00:00:00
abstract:BACKGROUND:Approximately 2% of all pregnancies are ectopic; of these, 4% are interstitial or cervical. There exists no clear consensus as to whether surgical or medical management is superior. CASE:We present three cases of advanced nonfallopian tube ectopic pregnancies from 6 to 8 weeks of gestation. Our first two ca...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31828d58ee
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To establish the optimum oral daily dose of micronized medroxyprogesterone acetate, given in combination with a fixed oral dose of estrone (E1) sulfate as hormone replacement therapy, that provides endometrial protection and induces cessation of vaginal bleeding. METHODS:This multicenter, randomized, double-...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0029-7844(98)00038-6
更新日期:1998-05-01 00:00:00
abstract::Twelve women with tubal pregnancies were treated with intratubal transvaginal methotrexate injection (1 mg/kg body weight). Serum beta-hCG levels decreased in all patients, and the resolution time from injection to undetectable beta-hCG levels was 14-120 days. In spite of declining serum beta-hCG and unruptured tubal ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1991-04-01 00:00:00
abstract:BACKGROUND:We report a rare case of a cervical adenosquamous carcinoma, initially diagnosed during delivery, with subsequent implantation in the episiotomy scar 5 weeks postpartum. CASE:A 35-year-old woman with cervical adenosquamous carcinoma diagnosed during delivery was treated with radical abdominal hysterectomy w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000275260.45730.ea
更新日期:2007-08-01 00:00:00
abstract::Periodic assessments offer an excellent opportunity for obstetricians and gynecologists to provide preventive screening, evaluation, and counseling. The American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice recommends routine assessments in primary and preventive care for women based o...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0b013e318219226e
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Alimentary tract duplications are rare congenital lesions that may arise at any location throughout the gastrointestinal tract. The most common site of enteric duplications is the ileum, with only 13% of cases occurring in the colon. CASE:Prenatal sonography at 39 weeks' gestation showed a cystic structure ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:2003-05-01 00:00:00
abstract::The role of Neisseria gonorrhoeae in the etiology and pathogenesis of acute salpingitis and its relationship to nongonococcal salpingitis were investigated. To accomplish this goal, isolated microorganisms obtained from the fallopian tubes and cul-de-sac via laparoscopy were evaluated in relation to the number of epis...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-07-01 00:00:00
abstract::The maternal serum alpha-fetoprotein (AFP) in 6161 women in routine pregnancy [2771 in a hospital obstetric clinic (group 1) and 3390 in private practices (group 2)] was studied. Group 1 studies enabled the delineation of the normal range of serum AFP, whereas group 2 represented a true screening experience. In group ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::Hemoperitoneum was identified by culdocentesis in a 26-year-old woman suffering acute abdominal pain. A pregnancy test was positive. Operation indicated a ruptured ovarian pregnancy, and histologic examination revealed primary intrafollicular ovarian pregnancy in a cystic teratoma. Ovarian pregnancy in an ovarian tumo...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198409001-00014
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVE:To quantify the current perinatal consequences associated with intrapartum detection of meconium in the amniotic fluid (AF). METHODS:We compared retrospectively the outcomes in 8136 term singleton cephalic pregnancies with meconium and 34,573 similar pregnancies with clear AF. RESULTS:Virtually all measures...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-03-01 00:00:00
abstract::Combination chemotherapy has dramatically improved the results of treatment for embryonal rhabdomyosarcoma of the vagina in children, but little attention has been directed toward vaginal sarcomas in adults. This report of 17 cases of primary sarcoma of the adult vagina includes ten leiomyosarcomas, four mixed mesoder...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-05-01 00:00:00
abstract:OBJECTIVE:To assess whether lack of patient preparation for common physical and emotional postpartum symptoms is associated with patient satisfaction with obstetric clinicians. METHODS:We conducted a telephone survey of 724 postpartum women. Women were interviewed 2 weeks postpartum to assess self-perceived preparatio...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181c8b39b
更新日期:2010-02-01 00:00:00
abstract::Recent studies using newly devised serologic techniques have dramatically advanced our understanding of gonadal organogenesis and aberrant sexual differentiation. Thus XY gonadal dysgenesis, XX male syndrome, and XX true hermaphroditism, for example, may be seen as typifying specific errors of regulation, synthesis, o...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:
更新日期:1979-12-01 00:00:00
abstract:OBJECTIVE:To characterize the use of venous thromboembolism prophylaxis during antepartum and postpartum hospitalizations in the United States. METHODS:A retrospective cohort study using the Perspective database was performed to analyze temporal trends of mechanical and pharmacologic venous thromboembolism prophylaxis...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002099
更新日期:2017-08-01 00:00:00