Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction

Contraception. 2021 Jan;103(1):6-12. doi: 10.1016/j.contraception.2020.10.018. Epub 2020 Oct 29.


Objective: We evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn.

Study design: We implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ's effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points.

Results: In primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69-76%, p = 0.58), but increased patient satisfaction (81-97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction.

Conclusions: Implementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling.

Implications: Further studies of the impact of clinic-level implementation of OKQ are needed.

Keywords: Contraceptive counseling; Preconception counseling; Pregnancy intentions; Primary care; Reproductive life plan.

MeSH terms

  • Counseling
  • Family Planning Services
  • Humans
  • Obstetrics*
  • Patient Satisfaction*
  • Primary Health Care
  • Reproductive Health