Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services

Abstract

Purpose The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. Methods Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. Results Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. Conclusions The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities.

Teen Pregnancy Prevention: Implementation of a Multicomponent, Community-Wide Approach

“…In addition, given indications of the importance of increasing contraceptive use among teens to declining teen birth rates nationally [9,10], increasing teen access to high-quality sexual and reproductive health services was identified as the second key element of the model. State- and community-based organizations were to work with local health centers to improve implementation of evidence-based guidelines for adolescent reproductive health care [11]. Implementation of these guidelines has been linked to greater use of highly effective contraception and youth satisfaction with services received [12–18].…”

“…The baseline assessments were used to identify needs and develop individualized TTA plans for each partner. Needs assessments were conducted annually to monitor progress and update TTA plans [11,31,33]. Each state- and community-based organization conducted additional assessments of their community to supplement the baseline assessments using existing data sources and collecting information from focus groups, interviews, or surveys of adults and youth in their community.…”

Nurses on the Front Lines

“…24 The following sections highlight some recommendations for providing sexual and reproductive health care.…”

Efforts to Increase Implementation of Evidence-Based Clinical Practices to Improve Adolescent-Friendly Reproductive Health Services

“…As previously described [37], results from the baseline health center assessment (2011) were used to identify opportunities for improvement in the implementation of the evidence-based clinical practices. Health center improvement plans were developed for each health center partner.…”