Feasibility study of family planning services screening as clinical decision support at an urban Federally Qualified Health Center network

Abstract

Objective: The objective was to assess the feasibility of an intervention introducing family planning services screening clinical decision support to improve provision of contraception and/or preconception services for women of reproductive age in our primary care Federally Qualified Health Center (FQHC) network.

Study design: We implemented a family planning services screening prompt for support staff to ask women 13-44 years at nonobstetric visits at specified time intervals. The response was displayed in the electronic medical record for the provider to review, linked to a documentation tool. We evaluated staff comfort with the screening before and after rollout at all seven FQHC sites. At the pilot site, we examined implementation feasibility by assessing screening rate and the outcome measure of family planning (contraception and/or preconception) documentation during visits by women 13-44 years before and during the intervention's first year.

Results: At baseline, support staff reported high level of comfort (60% very, 25% somewhat) in asking the family planning services screening question; this increased to 80% reporting they were "very comfortable" in the postsurvey (p = <.01). From mid-December 2016-mid-January 2018, the screening question was displayed for 1503 visits at the pilot site, of which 96% had a documented response. Family planning documentation rate at the pilot site showed a 6% increase from 64% during the preintervention period to 70% during the 13-month intervention period (p<.01). Time series analysis demonstrated more positive upward trend attributed to the intervention period (intervention R²=0.15 vs. preintervention R²=0.01).

Conclusion: Our study demonstrated high staff acceptability of the intervention at all sites and a high screening rate with a significant increase in family planning documentation rate at the pilot site during the intervention period. This suggests that this family planning services screening decision support intervention is feasible in an FQHC setting.

Implications: Implementation of a family planning services screening decision support intervention is feasible in an FQHC setting. Further evaluation of performance at multiple sites, accounting for variable site characteristics, is needed.

Keywords: Contraception; Family medicine; Family planning services; Preconception; Primary care; Reproductive intention screening.