Increase in Contraceptive Counseling by Primary Care Clinicians After Implementation of One Key Question® at an Urban Community Health Center

Stulberg, Debra; Dahlquist, Irma; Disterhoft, Judith; Bello, Jennifer K.; Hunter, Michele Stranger

doi:10.1007/s10995-019-02754-z

Cited by 34 publications

(26 citation statements)

References 16 publications

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“… 100 – 102 The “One Key Question,” “Would you like to become pregnant in the next year?” is a brief, validated approach to assessing family planning goals and can inform individualized, patient-centered counseling. 103 Programs should offer comprehensive contraception options in clinic or via referral, including long-acting reversible contraception (LARC), to all people who may become pregnant and are not planning a pregnancy. Care should be taken to avoid coercion in contraception acceptance and method selection.…”

Section: Creating a Therapeutic Environmentmentioning

confidence: 99%

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

et al. 2021

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Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06904-4.

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Section: Creating a Therapeutic Environmentmentioning

confidence: 99%

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

et al. 2021

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“…has been proven to increase the proportion of women receiving CC within primary care settings in the USA. 27 In contrast, our intervention included four key questions. Our questions were formulated to make the participant reflect on their reproductive life plan and pregnancy intention.…”

Section: Previously a Discrepancy Between What Women Need And Wantmentioning

confidence: 99%

Evaluation of satisfaction with a model of structured contraceptive counseling: Results from the LOWE trial

Envall

Iwarsson

Bizjak

et al. 2021

Acta Obstet Gynecol Scand

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IntroductionIntervention trials of structured contraceptive counseling have proved to increase use of long‐acting reversible contraceptives (LARCs) and decrease numbers of unintended pregnancies. However, these interventions have not been evaluated from a user perspective. This study aimed to evaluate both healthcare providers’ and participants’ satisfaction with an intervention used in a large trial in Sweden.Material and methodsA cross‐sectional study on the intervention group from a cluster randomized trial conducted at 28 clinics in Stockholm, Sweden. Clinics were randomized (1:1 allocation ratio) to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of four parts; an educational video to be seen by the participant prior to contraceptive counseling, key questions to be asked by the healthcare provider, an effectiveness chart, and a box of contraceptive models. Eligible participants were 18 years or older, sexually active without a wish to conceive, and with the main purpose of contraceptive use being pregnancy prevention. Healthcare providers completed an electronic semi‐structured survey to evaluate the intervention. This study analyses provider and participant satisfaction with the counseling material used in the intervention and if the intervention was found to be supportive in contraceptive counseling and contraceptive choice. Trial registration: ClinicalTrials.gov (NCT03269357).ResultsFourteen intervention clinics enrolled 658 participants from September 2017 to May 2019. Response rate among providers was 88.0% (55/62) and among participants 97.1% (639/658). Providers found the intervention to be supportive in their counseling. Each separate part of the intervention package received high ratings from both providers and participants. Participants found the educational video and the effectiveness chart to be more helpful than the box of contraceptive models in their contraceptive choice. Providers reported the time taken to complete the intervention outside the study to be time‐neutral to standard counseling, and most providers wished to continue to use all parts of the intervention package.ConclusionsThe intervention of structured contraceptive counseling had high provider and participant satisfaction. The structured counseling package could be used in several clinical settings to improve quality in contraceptive counseling and to enhance informed decision making about use of contraceptive methods.

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“…Evidence-based preconception care (PCC) interventions aim to identify and treat health conditions, assist with behavior modification, and mitigate risk factors that may contribute to poor maternal and infant outcomes [ 7 ]. However, despite recommendations from the Centers for Disease Control and Prevention (CDC), [ 6 ] and the development of indicators for PHHC, [ 8 , 9 ] the delivery of PCC- particularly preconception counseling for women of child bearing-age by clinicians in community-based settings remains a challenge [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Incorporating high quality PHHC with a focus on screening, counseling, health behavior modification and treatment in health care settings, and facilitating patient-provider shared decision making in the clinical process has the potential for reducing disparities in maternal and infant outcomes. Thus far, PHHC implementation research efforts in clinical settings have been limited by small sample size and single-site recruitment, [ 10 ] and a lack of frameworks (theoretical or implementation) to support implementation and effectiveness outcomes. Additionally, there is a gap in research documenting implementation of evidence-based PCC screening and education tools specifically designed for Black and African American women in community-based settings.…”

Section: Introductionmentioning

confidence: 99%

“…The slow uptake of PCC in healthcare and the lack of engagement between women and healthcare providers in shared decision making about PHHC can be attributed to limited resources (lack of time in the clinical encounter, guidelines, and reimbursement); provider barriers (lack of knowledge of PHHC, lack of clarity on specialty responsible for providing PHHC, poor coordination and organization of PHHC); and patient level factors (lack of knowledge of PHHC, not meeting with a healthcare provider during the preconception stage) [10][11][12][13][14]. Incorporating high quality PHHC with a focus on screening, counseling, health behavior modification and treatment in health care settings, and facilitating patientprovider shared decision making in the clinical process has the potential for reducing disparities in maternal and infant outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women

Walter

Julce

Sidduri

et al. 2020

BMC Health Serv Res

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Background Improving the health of women before pregnancy and throughout a woman’s lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S. Methods This is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25–50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change. Discussion This study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention. Trial registration ClinicalTrials.gov NCT04514224. Date of registration: August 14, 2020. Retrospectively Registered.

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Increase in Contraceptive Counseling by Primary Care Clinicians After Implementation of One Key Question® at an Urban Community Health Center

Cited by 34 publications

References 16 publications

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Evaluation of satisfaction with a model of structured contraceptive counseling: Results from the LOWE trial

Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women

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