Abstract
Objective
Routine pregnancy-intention screening in the primary care setting is a promising practice
to help patients achieve their reproductive goals. We aim to describe the utilization
of a pregnancy-intention screening tool integrated in the electronic health record
(EHR) of a national network of community health centers (CHCs) and identify clinic-level
factors associated with tool use.
Study design
We conducted a clinic-level retrospective observational study to assess tool utilization
during the first 3 years after the tool was made available in the EHR (November 2015
to October 2018). We describe characteristics of clinics with higher tool utilization
(≥90th percentile) versus lower utilization (<90th percentile) and the types of providers
who used the tool. We then employ negative binomial regression to identify independent
clinic-level factors associated with tool utilization.
Results
Across 194 clinics in our study sample which served 289,754 eligible female patients,
the tool was used for 113,116 (39%). Medical assistants performed 60.3% of screenings
and clinicians performed 11.2%. CHCs with higher tool utilization rates were more
likely to be located in rural settings (RR 1.75, 95% CI 1.07–2.87) and serve patient
populations with higher proportions of women (RR 1.32, 95% CI 1.24–1.41) and lower
proportions of patients with non-English language preference (RR 0.92, 95% CI 0.89–0.95).
Conclusions
Many health centers utilized pregnancy-intention screening after an EHR-based tool
was made available, though overall screening rates were low.
Implications
Additional study of implementation strategies and effectiveness of pregnancy-intention
screening tools is needed. Implementation of future pregnancy-intention screening
interventions must be tailored to address clinic-level barriers and facilitators to
screening.
Keywords
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Article info
Publication history
Published online: February 12, 2021
Accepted:
February 9,
2021
Received in revised form:
February 4,
2021
Received:
September 10,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
