Abstract
Objective
The objective was to assess the feasibility of an intervention introducing family
planning services screening clinical decision support to improve provision of contraception
and/or preconception services for women of reproductive age in our primary care Federally
Qualified Health Center (FQHC) network.
Study design
We implemented a family planning services screening prompt for support staff to ask
women 13–44 years at nonobstetric visits at specified time intervals. The response
was displayed in the electronic medical record for the provider to review, linked
to a documentation tool. We evaluated staff comfort with the screening before and
after rollout at all seven FQHC sites. At the pilot site, we examined implementation
feasibility by assessing screening rate and the outcome measure of family planning
(contraception and/or preconception) documentation during visits by women 13–44 years
before and during the intervention's first year.
Results
At baseline, support staff reported high level of comfort (60% very, 25% somewhat)
in asking the family planning services screening question; this increased to 80% reporting
they were “very comfortable” in the postsurvey (p = <.01). From mid-December 2016–mid-January
2018, the screening question was displayed for 1503 visits at the pilot site, of which
96% had a documented response. Family planning documentation rate at the pilot site
showed a 6% increase from 64% during the preintervention period to 70% during the
13-month intervention period (p<.01). Time series analysis demonstrated more positive
upward trend attributed to the intervention period (intervention R2=0.15 vs. preintervention R2=0.01).
Conclusion
Our study demonstrated high staff acceptability of the intervention at all sites and
a high screening rate with a significant increase in family planning documentation
rate at the pilot site during the intervention period. This suggests that this family
planning services screening decision support intervention is feasible in an FQHC setting.
Implications
Implementation of a family planning services screening decision support intervention
is feasible in an FQHC setting. Further evaluation of performance at multiple sites,
accounting for variable site characteristics, is needed.
Keywords
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Article info
Publication history
Published online: October 15, 2018
Accepted:
October 8,
2018
Received in revised form:
September 29,
2018
Received:
March 10,
2018
Footnotes
☆Declarations of interest: none.
☆☆Funding: The intervention is supported by grant funding from the Public Health Solutions, New York, NY. The funding source was not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Dr. Shah received salary support from the Empire Clinical Research Investigator Program.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
