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

Abstract

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.
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Debra Stulberg
11/21/2020

Great poster and video, Meron!

Meron Ferketa
11/21/2020

Thank you!

Jack
jwestfall@aafp.org 11/21/2020

great project. thanks for making sure women have access to full reproductive healthcare. and thank you for sharing this with NAPCRG. https://www.graham-center.org/rgc/home.html

Meron Ferketa
11/23/2020

Thank you!

Tyler Barreto
11/22/2020

Great work and presentation! How were the two practice sites chosen? Because time seems to be a big barrier mentioned before implementation, I wonder how the size of the "time barrier" may be different in different types of clinics. In other words, I would guess that a clinic team seeing 8 patients in a half day may think this is less of a problem than a clinic team seeing 15 patients in a half day. Any thoughts on this? Thank you!

Meron Ferketa
11/23/2020

Thank you for your question! The two practices were chosen because they implemented OKQ previously in their clinic as part of a pilot study and so we used these clinics to assess implementation of the tool by interviewing the clinicians and staff. Your point about how different clinics might perceive the time barrier based on the relative number of patients being seen is interesting and could be something we look into further! The family medicine clinic, for example is bigger in terms of staff than the OB/GYN clinic but I am not certain that one clinic was seeing more patients in a half day than another. One issue that did come up along these lines is how the different clinics may be perceiving the time barrier based on their clinic type. Perhaps for a family medicine clinic, taking time to discuss reproductive goals seems like more of an interruption because the patient is there for a cold, whereas in an OB/GYN clinic, it would be expected that patients and clinicians would be having these types of discussions.

Tai Doo
11/22/2020

Great work! Such a great question for assessing patient's goals! -University of Chicago NS FM resident PGY3

Meron Ferketa
11/23/2020

Thank you!

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