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Feasibility study of family planning services screening as clinical decision support at an urban Federally Qualified Health Center network.

Research paper by Seema D SD Shah, Linda L Prine, Eve E Waltermaurer, Susan E SE Rubin

Indexed on: 20 Oct '18Published on: 20 Oct '18Published in: Contraception



Abstract

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. We implemented a family planning services screening prompt for support staff to ask women 13-44years at non-obstetric visits at specified time intervals. The response 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 roll-out 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 13-44years before and during the intervention's first year. 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 post-survey (p=<0.01). From mid-December 2016-mid-January 2018, the screening question 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 pre-intervention 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 R=0.15 vs. pre-intervention R=0.01). 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 a FQHC setting. Implementation of a family planning services screening decision support intervention is feasible in a FQHC setting. Further evaluation of performance at multiple sites, accounting for variable site characteristics, is needed. Copyright © 2018. Published by Elsevier Inc.