Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings

Srinivasulu, Silpa; Shah, Seema D.; Schechter, Clyde B.; Prine, Linda; Rubin, Susan E.

doi:10.1016/j.contraception.2019.11.002

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…This study adds to the literature evaluating a reproductive health service screening question in primary care by exploring New York women's interpretations. 21–23 , 27 , 28 Our findings indicate face validity, in that women of reproductive age interpreted the question as it was intended. Implementing a routine, open-ended services-based screening question in primary care, such as our proposed question, may increase patients' awareness of SRH service availability, enable providers to respond to patients' SRH needs directly in primary care, and enhance patient-centered care overall.…”

Section: Discussionmentioning

confidence: 55%

“…26 This screening question was integrated into practice and tested for feasibility and outcomes within a large Federally Qualified Health Center network in New York City and resulted in a modest 3.4% average adjusted increase in the documentation of family planning services, including counseling, across seven sites, with more work needed to improve implementation equally across sites. 27 , 28 …”

Section: Introductionmentioning

confidence: 99%

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Women's Perspectives on a Reproductive Health Services Screening Question: An Alternative to Pregnancy Intention Screening

Srinivasulu

Manze

Jones

2022

Women's Health Reports

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Background Current efforts to integrate reproductive health care into primary care in the United States involve assessing pregnancy intentions and reproductive goals, which are often not meaningful or attainable for some. Alternatively, we designed a reproductive health services-based screening question: “Can I help you with any reproductive health services today, such as preventing pregnancy or planning a healthy pregnancy?” In this study, we describe women's interpretations of this question as part of a larger study, exploring perspectives on reproductive health care quality in primary care. Materials and Methods We utilized a third-party research firm to recruit New York women of reproductive age (18–45), who visited a primary care provider in the past year. We conducted five focus groups and eight interviews ( N = 30). Semistructured guides queried participants on interpretations of the screening question and preferences for raising reproductive health concerns during a primary care visit. We employed inductive thematic analysis. Results Participants interpreted the question as offering contraception or pregnancy counseling and care, although younger participants also understood it as offering sexual and reproductive health services broadly. Participants also connected the question with discussions about their ability to conceive. Some participants described experiences with provider assumptions and implicit bias. Tensions emerged around accepting primary care as a setting for reproductive health due to a perceived lack of specialized training. Conclusions Participants interpreted the screening question as intended, indicating face validity. Primary care settings should increase patients' awareness of reproductive health service availability, such as by routinely introducing a services-based screening question.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Women's Perspectives on a Reproductive Health Services Screening Question: An Alternative to Pregnancy Intention Screening

Srinivasulu

Manze

Jones

2022

Women's Health Reports

Self Cite

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“…Ultimately, 44 papers were included in our review and are described in Table 1 (6, 12–54). Although published between 2015-2023, data were collected between 2012-2021.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of PIS/RLPs were employed verbally during clinical encounters (15 RLPs in 27 papers) (6, 16, 17, 22, 24, 25, 28–36, 38–42, 44, 45, 48, 49, 52–54), five were self-completed (written) RLPs studied in seven papers (14, 15, 21, 37, 46, 47, 50) and six were digital RLPs (13, 19, 20, 26, 43, 51), although one was designed to be used/completed with a midwife (26) and one was linked to primary care (51). Several PIS/RLP were implemented in different formats, for example, the OKQ, FPQ/RepLI and Moos were all asked both verbally during clinical encounters and self-completed (written).…”

Section: Resultsmentioning

confidence: 99%

A scoping review of the format, content, effectiveness and acceptability of reproductive life planning tools

Stewart,

Noh,

Pathak

et al. 2024

Preprint

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IntroductionA Reproductive Life Plan (RLP) is a set of questions that encourage patients to reflect on their reproductive goals and the actions needed to achieve them. This scoping review of the published and grey literature aims to map the evidence on currently available RLPs.MethodsWe searched four databases (Medline, Embase, PsycINFO and Scopus) and used Google to search the grey literature, the search terms were; “reproductive life plan$” OR “reproductive plans$” OR “pregnancy intention screening”. Data were extracted on target audience, format, content, behaviour change theory, features, effectiveness and acceptability.Results44 published papers and 18 grey literature sources were included. 21 RLPs were discussed in the published papers and 17 in the grey literature. Most RLPs came from the USA. Most RLPs in published papers were asked verbally, while all RLPs in the grey literature were self-completed; there were six digital RLPs. Most ask whether an individual wants children, some then ask about number and timing of children, and contraception. Grey literature RLPs also asked about lifestyle and health.DiscussionThe concept of developing an RLP is acceptable to people of reproductive age and healthcare professionals. There was a lot of consistency in the questions asked, however, there is limited data on effectiveness and only three tools, all digital, incorporated behaviour change theory.ConclusionA digital RLP that builds on the evidence for existing tools and integrates appropriate theory could result in the realisation of the potential that RLPs are theorised to deliver.

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“…Orenstein (2019) [56] Implem sites Implem effort: originating vs first remote vs second remote site, 384 vs 59.5 vs 26 person-hours ✓ Shah (2019) [57,58] Pre vs post Family planning documentation: pre, 55.7%; post, 58.4% (P < .001); AOR, 1.26 (CI, 1.17-1.36) ✓ DeSilva (2020) [59] POC alert ± order facil Pts screened: POC alert alone, 12.6%; POC alert with order facil, 15.7% (P = .002) ✓ Herbst (2020) [60] Pts ± consult ordered NRT for consulted inpatients: AOR, 1.93 (CI, 1.5-2.45); at discharge: AOR, 3 a N = 36 articles for 28 studies; 1 article per study except for 3 studies (Peiris; Price-Haywood; Shah) that had 2 articles each, 1 study (Tuot) with 3 articles, and 1 study (Gold) with 4 articles. For studies with > 1 article, year listed was the earliest year of the articles.…”

mentioning

confidence: 99%

Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review

et al. 2022

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Objectives: To review current studies about designing and implementing clinician-facing clinical decision support (CDS) integrated or interoperable with an electronic health record (EHR) to improve health care for populations facing disparities. Methods: We searched PubMed to identify studies published between January 1, 2011 and October 22, 2021 about clinician-facing CDS integrated or interoperable with an EHR. We screened abstracts and titles and extracted study data from articles using a protocol developed by team consensus. Extracted data included patient population characteristics, clinical specialty, setting, EHR, clinical problem, CDS type, reported user-centered design, implementation strategies, and outcomes. Results: There were 28 studies (36 articles) included. Most studies were performed at safety net institutions (14 studies) or Indian Health Service sites (6 studies). CDS tools were implemented in primary care outpatient settings in 24 studies (86%) for screening or treatment. CDS included point-of-care alerts (93%), order facilitators (46%), workflow support (39%), relevant information display (36%), expert systems (11%), and medication dosing support (7%). Successful outcomes were reported in 19 of 26 studies that reported outcomes (73%). User-centered design was reported during CDS planning (39%), development (32%), and implementation phase (25%). Most frequent implementation strategies were education (89%) and consensus facilitation (50%). Conclusions: CDS tools may improve health equity and outcomes for patients who face disparities. The present review underscores the need for high-quality analyses of CDS-associated health outcomes, reporting of user-centered design and implementation strategies used in low-resource settings, and methods to disseminate CDS created to improve health equity.

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Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings

Cited by 8 publications

References 23 publications

Women's Perspectives on a Reproductive Health Services Screening Question: An Alternative to Pregnancy Intention Screening

Women's Perspectives on a Reproductive Health Services Screening Question: An Alternative to Pregnancy Intention Screening

A scoping review of the format, content, effectiveness and acceptability of reproductive life planning tools

Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review

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