SRF027: Facilitators of and Barriers to Successful Implementation of the One Key Question Pregnancy Intention Screening Tool
Meron Ferketa; Kellie Schueler, BA; Bonnie Song, BS; Debra Stulberg, MD; Emily White VanGompel, MD, MPH
Context: The Centers for Disease Control and Prevention recommend that primary care clinicians routinely assess patients’ reproductive goals and provide contraceptive and/or preconception counseling accordingly. However, non-pregnant, reproductive-aged women received family planning services in only 14% of ambulatory care visits from 2009-2010 based on nationally representative data. Several provider-level and systems-level barriers contribute to low rates of reproductive counseling in primary care settings. One solution is incorporating pregnancy intention screening tools, such as One Key Question (OKQ), into routine clinical care. OKQ has been shown to correlate with validated measures of desire to avoid pregnancy and its implementation is associated with increased rates of contraceptive counseling. Although promising, broad use remains elusive, and further investigation into OKQ implementation is needed to maximize its effectiveness in real-life clinical settings. Objective: Using the Consolidated Framework for Implementation Research (CFIR), assess how clinicians and staff at two practices perceived OKQ and explore the barriers and facilitators encountered in implementing OKQ. Human Subjects Review: Deemed exempt by the University of Chicago IRB. Design: Qualitative interviews were conducted with physicians, nurses, medical assistants, and other staff from two clinics, which previously implemented OKQ. Using CFIR, a semi-structured interview guide was developed to assess the factors that affected OKQ implementation. Interviews occurred mostly over the phone. All interviews were recorded, transcribed, and analyzed for important themes. Setting: One OB/GYN and one family medicine practice, both associated with a non-profit health system. Anticipated Results: Preliminary results show that the involvement of local champions and clinic leadership was key to successful OKQ implementation. Barriers included competing medical issues and inadequate systems for follow-up to address patients’ OKQ responses. Participants expressed pre-implementation concerns that OKQ would increase visit lengths and interrupt workflow, yet most participants noted that it had a minimal impact on their workflow during implementation. Salient recommendations included integration of OKQ into the EMR, and the importance of detailed implementation planning early in the process. Conclusion: Results will be used to develop recommendations for effective implementation of OKQ in the future.