Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care

Abstract

Context:Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown.Methods:We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect.Results:Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7). Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9), and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6) being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2).Conclusions:Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes and reduced costs.

Publicly Funded Family Planning: Lessons From California, Before And After The ACA’s Medicaid Expansion

“…46 As some Medi-Cal Managed Care participants have reported being assigned to unfamiliar primary care providers, whose offices may not be accessible by public transportation, 30 the state has commissioned an access assessment 47 that is currently underway. 48 Of further concern, few primary care providers routinely assess pregnancy intentions and contraceptive need 49 and even fewer primary care providers have been trained to place intrauterine or subdermal contraception; fewer than 20% of family physicians report routinely placing or removing intrauterine or subdermal contraceptives. 50 Additional barriers to providing family planning services in Medicaid Managed Care Organizations include churning in enrollment 51 and the costs to clinics of stocking IUDs and contraceptive implants for placement when needed.…”

“If You Don't Ask, I'm Not Going to Tell You”: Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care

“…Assessing PI in primary care aligns with patient-centered counseling, a key component of which is optimizing patients' decision making (Barry & Edgman-Levitan, 2012;Dehlendorf, Fox, Sobel, & Borrero, 2016). Numerous efforts have been made to develop standardized tools that 1) routinize and standardize the process of assessing primary care patients' PI (Allen, Hunter, Wood, & Beeson, 2017;Bellanca & Hunter, 2013;Bello, Adkins, Stulberg, & Rao, 2013;Callegari, Aiken, Dehlendorf, Cason, & Borrero, 2017), 2) can be integrated into the clinical record (Simons & Kohn, 2018;Thiel de Bocanegra, McKean, Darney, Saleeby, & Hulett, 2017), and 3) are able to inform surveillance of family planning service delivery on a population level (Gavin et al, 2014).…”

Improvement of pregnancy counselling and contraception counselling and documentation in a single rheumatology academic practice: a quality improvement project

“… 1 3 5 Studies are finding recurring barriers to pregnancy counselling conversations in rheumatology, including time limitations, lack of knowledge and resources of practitioners, and comfort with the topic. 5 These conversations are of higher priority in women with RMD as there is increased adverse outcomes are appreciated in pregnant women with RMD versus non-RMD pregnant women, likely related to uncontrolled disease state at time of conception and teratogenic medications. 1 Comparable rates of unintended pregnancy have been demonstrated in those with and without RMD, even further raising the priority of these discussions and education of patients as a part of regular rheumatology office visits.…”

“…Reviewing provider documentation and billing codes is one way, which researchers have estimated pregnancy counselling and contraception counselling. 5 Thiel de Bocanegra et al performed a review of 1054 Medicaid managed care visits of women aged 13–49, which demonstrated a presence of only ‘12% of charts had documentation of pregnancy intention and 59% documented contraceptive use or billing codes’. 5 This would suggest that very few discussions about pregnancy counselling and contraception are occurring during these visits.…”

“… 5 Thiel de Bocanegra et al performed a review of 1054 Medicaid managed care visits of women aged 13–49, which demonstrated a presence of only ‘12% of charts had documentation of pregnancy intention and 59% documented contraceptive use or billing codes’. 5 This would suggest that very few discussions about pregnancy counselling and contraception are occurring during these visits. In this quality improvement project of a single-centre rheumatology clinic, we elected to evaluate similarly using documentation and billing codes for pregnancy counselling and contraception counselling occurrence in females of reproductive age on leflunomide, mycophenolate, methotrexate or cyclophosphamide.…”