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

• Published in: Maternal and child health journal 2019-08, Vol.23 (8), p.996-1002
• Main Authors: Stulberg, Debra B., Dahlquist, Irma H., Disterhoft, Judith, Bello, Jennifer K., Hunter, Michele Stranger
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Birth control; Brief Reports; Chicago; Community Health Services - methods; Community Health Services - trends; Contraception Behavior - trends; Contraceptives; Counseling; Counseling - methods; Counseling - standards; Family planning; Family planning services; Family Planning Services - methods; Family Planning Services - trends; Female; Gynecology; Health aspects; Health counseling; Humans; Long-Acting Reversible Contraception - methods; Long-Acting Reversible Contraception - trends; Maternal and Child Health; Medical care; Medicine; Medicine & Public Health; Methods; Middle Aged; Needs assessment; Pediatrics; Population Economics; Pregnancy; Primary care; Primary health care; Primary Health Care - methods; Primary Health Care - trends; Prospective Studies; Public Health; Reproductive health; Sociology; Statistics; Supply and demand; Surveys and Questionnaires; Training; Urban areas; Urban health; Urban Health Services - trends; Women; Womens health
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-019-02754-z

Introduction To provide quality family planning services and reduce racial and socioeconomic disparities in unintended pregnancy and pregnancy outcomes, primary care clinicians should routinely assess women’s reproductive health needs and provide patient-centered contraceptive and preconception counseling. One Key Question® asks women if they would like to become pregnant in the next year and prompts clinicians to provide counseling appropriate to each patient. We conducted a pilot study to assess if implementing One Key Question® in the Electronic Medical Record (EMR) of an urban community health center, coupled with brief clinician training, would increase rates of contraceptive and preconception counseling. Methods We incorporated One Key Question® into a new EMR form and provided a brief training to primary care clinicians on reproductive life plan assessment, preconception counseling, and contraception. We surveyed women patients, ages 18–49, after their visit and compared pre- vsersus post-intervention rates of patient-reported contraceptive and preconception counseling. Results After One Key Question® was introduced in the clinic EMR and clinicians underwent brief training on its use, patients reported significantly higher rates of their clinician counseling them about contraception (52% vs. 76%, p = 0.040) and recommending a long-acting reversible contraceptive (LARC) method (10% vs. 32%, p = 0.035). There were no significant changes in preconception counseling. Discussion After EMR integration of One Key Question® coupled with brief clinician training, rates of contraceptive counseling and LARC recommendations increased in this community health center pilot study. Future research should compare One Key Question® to standard care in a prospective randomized trial.