Abstract
Introduction To provide quality family planning services and reduce racial and socioeconomic disparities in unintended pregnancy and pregnancy outcomes, primary care clinicians should routinely assess women’s reproductive health needs and provide patient-centered contraceptive and preconception counseling. One Key Question® asks women if they would like to become pregnant in the next year and prompts clinicians to provide counseling appropriate to each patient. We conducted a pilot study to assess if implementing One Key Question® in the Electronic Medical Record (EMR) of an urban community health center, coupled with brief clinician training, would increase rates of contraceptive and preconception counseling. Methods We incorporated One Key Question® into a new EMR form and provided a brief training to primary care clinicians on reproductive life plan assessment, preconception counseling, and contraception. We surveyed women patients, ages 18–49, after their visit and compared pre- vsersus post-intervention rates of patient-reported contraceptive and preconception counseling. Results After One Key Question® was introduced in the clinic EMR and clinicians underwent brief training on its use, patients reported significantly higher rates of their clinician counseling them about contraception (52% vs. 76%, p = 0.040) and recommending a long-acting reversible contraceptive (LARC) method (10% vs. 32%, p = 0.035). There were no significant changes in preconception counseling. Discussion After EMR integration of One Key Question® coupled with brief clinician training, rates of contraceptive counseling and LARC recommendations increased in this community health center pilot study. Future research should compare One Key Question® to standard care in a prospective randomized trial.
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References
Akers, A. Y., Gold, M. A., Borrero, S., Santucci, A., & Schwarz, E. B. (2010). Providers’ perspectives on challenges to contraceptive counseling in primary care settings. Journal of Womens Health, 19(6), 1163–1170. https://doi.org/10.1089/jwh.2009.1735.
Allen, D., Hunter, M. S., Wood, S., & Beeson, T. (2017). One Key Question(®): first things first in reproductive health. Maternal and Child Health Journal, 21(3), 387–392. https://doi.org/10.1007/s10995-017-2283-2.
American Academy of Family Physicians (AAFP). (2016). Preconception Care (Position Paper). Retrieved February 7, 2019, from https://www.aafp.org/about/policies/all/preconception-care.html.
American College of Obstetricians and Gynecologists (ACOG). (2016). Committee Opinion No. 654: reproductive life planning to reduce unintended pregnancy. Obstetrics and Gynecology, 127, e66–e99.
Bellanca, H. K., & Hunter, M. S. (2013). ONE KEY QUESTION®: preventive reproductive health is part of high quality primary care. Contraception, 88(1), 3–6. https://doi.org/10.1016/j.contraception.2013.05.003.
Bello, J. K., Adkins, K., Stulberg, D. B., & Rao, G. (2013a). Perceptions of a reproductive health self-assessment tool (RH-SAT) in an urban community health center. Patient Education and Counseling, 93(3), 655–663.
Bello, K. J., Adkins, K., Stulberg, D., & Rao, G. (2013b). What is the effect of a self-administered reproductive life plan (RLP) on preconception and contraceptive counseling? Contraception, 88(3), 461. https://doi.org/10.1016/j.contraception.2013.05.117.
Bello, J. K., Rao, G., & Stulberg, D. B. (2015). Trends in contraceptive and preconception care in United States ambulatory practices. Family Medicine, 47(4), 264–271.
Bensing, J., Verhaak, P. F., van Dulmen, A. M., & Visser, A. P. (2000). Communication: the royal pathway to patient-centered medicine. Patient Education and Counseling, 39, 1–3.
Burgess, C. K., Henning, P. A., Norman, W. V., Manze, M. G., & Jones, H. E. (2018). A systematic review of the effect of reproductive intention screening in primary care settings on reproductive health outcomes. Family Practice, 35(2), 122–131.
Callegari, L. S., Aiken, A. R. A., Dehlendorf, C., Cason, P., & Borrero, S. (2017). Addressing potential pitfalls of reproductive life planning with patient-centered counseling. American Journal of Obstetrics and Gynecology, 216(2), 129–134.
Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2015). Pregnancy-related mortality in the United States, 2006–2010. Obstetrics and Gynecology, 125(1), 5–12.
Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine, 374(9), 843–852.
Gavin, L., Moskosky, S., Carter, M., Curtis, K., Glass, E., Godfrey, E., … Zapata, L. (2014). Providing quality family planning services: recommendations of CDC and the U.S. office of population affairs. MMWR Recommendations and Reports, 63(RR-04), 1–54.
Howell, E. A., Brown, H., Brumley, J., Bryant, A. S., Caughey, A. B., Cornell, A. M., … Grobman, W. A. (2018). Reduction of peripartum racial and ethnic disparities: a conceptual framework and maternal safety consensus bundle. Obstetrics & Gynecology, 131(5), 770–782. https://doi.org/10.1097/aog.0000000000002475.
MacDorman, M. F., & Mathews, T. J. (2011). Understanding racial and ethnic disparities in U.S. infant mortality rates. NCHS Data Brief, no. 74. Hyattsville, MD: National Center for Health Statistics.
Miller, W. B., Barber, J. S., & Gatny, H. H. (2013). The effects of ambivalent fertility desires on pregnancy risk in young women in the USA. Population studies, 67(1), 25–38.
Saada, A., Grzeniewski, M., & Tobier, N. (2015). Improving contraceptive services in primary care: a quality improvement collaborative pilot (published abstract). Contraception, 92(4), 364.
Schwarz, E. B., Santucci, A., Borrero, S., Akers, A. Y., Nikolajski, C., & Gold, M. A. (2009). Perspectives of primary care clinicians on teratogenic risk counseling. Birth Defects Research, Part A: Clinical and Molecular Teratology, 85(10), 858–863.
Steiner, M. J., Trussell, J., Mehta, N., Condon, S., Subramaniam, S., & Bourne, D. (2006). Communicating contraceptive effectiveness: a randomized controlled trial to inform a World Health Organization family planning handbook. American Journal of Obstetrics and Gynecology, 195(1), 85–91.
Wood, S. F., Beeson, T., Goldberg, D. G., Mead, K. H., Shin, P., Abdul-Wakil, A., … Rosenbaum, S. (2015). Patient experiences with family planning in community health centers. Geiger Gibson/RCHN Community Health Foundation Research Collaborative. Retrieved February 7, 2019, from https://publichealth.gwu.edu/sites/default/files/Geiger_Gibson_Family_Planning_Report_2015.pdf.
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Michele Stranger Hunter is the One Key Question® consultant with Power To Decide, the non-profit organization that owns the trademark on One Key Question®. All proceeds from the licensing of One Key Question® go into further OKQ program development consistent with the mission of Power To Decide, which can be found at https://powertodecide.org/about-us. Authors report no other conflicts.
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Stulberg, D.B., Dahlquist, I.H., Disterhoft, J. et al. Increase in Contraceptive Counseling by Primary Care Clinicians After Implementation of One Key Question® at an Urban Community Health Center. Matern Child Health J 23, 996–1002 (2019). https://doi.org/10.1007/s10995-019-02754-z
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DOI: https://doi.org/10.1007/s10995-019-02754-z