Contraceptive Access Change Package Best Practice 2 Last Reviewed November 2017 1 Introduction to the Contraceptive Access Change Package Best Practice Recommendations Stock all methods Utilize patientcentered counseling ID: 679601
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Discuss Pregnancy Intention and Support Patients through Evidence-Informed, Patient-Centered Counseling
Contraceptive Access Change Package Best Practice 2
Last Reviewed November 2017
1Slide2
Introduction to the Contraceptive Access Change Package
Best Practice RecommendationsStock all methods
Utilize patient-centered counselingOffer same-visit accessReduce cost as a barrier
Link:
https
://
www.fpntc.org/resources/contraceptive-access-change-package
2Slide3
Contraceptive Access Change Package: Best
Practice 2Discuss pregnancy intention
and support patients through evidence-informed, patient-centered counseling that enables them to choose from the full range of contraceptive methods if they do not desire pregnancy presently
3Slide4
Meeting Objectives
By the end of today, you should be able to:Describe the rationale for using a shared decision-making approach to contraceptive counselingIdentify at least two
best practice strategies for ensuring counseling is patient-centeredIdentify at least two strategies for ensuring providers routinely assess patients’ pregnancy intention and need for contraceptive counseling
4Slide5
Rationale for Routine, Patient-Centered Counseling
Evidence-informed counseling helps patients identify the most appropriate contraceptive method for themAdhering to a patient-centered counseling approach can
Increase patient knowledge, use, and satisfaction with servicesReduce risk of reproductive coercion and provider bias5Slide6
Overview of Strategies
Discuss pregnancy intention routinely with all patients of reproductive age
Regardless of reason for visitIncluding male and female patientsCounsel in accordance with QFP guidelinesHave a policy of voluntary services
6Slide7
Contraceptive Access Assessment
7Slide8
Discussion of Current Implementation of Best
PracticeWhat counseling practices are most frequently being done? What helps contribute to routine implementation of these practices?
What practices are least frequently being done? What is challenging about these practices in particular?8Slide9
Routine Assessment of Reproductive Intention
Opens the door for discussion of unmet reproductive health needs“Do you think you would like to have (more) children some day?1
When do you think that might be?How important is it to you to prevent pregnancy (until then)?” Ask every patient at least annually (male and female), regardless of reason for initial visit
1
Callegari
et
al. Am J Obstet Gynecol. 2017 . 9Slide10
Discussion of Challenges Related to Assessing Pregnancy Intention
(How) are you routinely (at least annually) assessing pregnancy intention?
Regardless of initial reason for visitAll male and female patients of reproductive ageWhat is currently working well?What is challenging about routine assessment pregnancy intention?
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5 Principles of Quality Counseling (QFP)
If a patient wants to prevent pregnancy, the provider should counsel according to QFP recommendations for quality counseling:Establish and maintain rapport with the client;
Obtain clinical and social information;Work with the client interactively to select the most effective and appropriate method;Conduct a physical assessment, when warranted;
Provide method, help the client develop a plan for using the method and for follow-up, and confirm client understanding.
11Slide12
Approaches to Counseling
Approach
Drawbacks
Informed Choice:
Provide information about all methods
Foreclosed:
Ask patients “
What methods are you interested in?” provide information about those methods
Time-consuming
A lot of information, and information that is out of context for the patient
Patient may not be aware of all methods
Patient may not have accurate information about non-discussed methods
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Shared Decision Making
Collaborative process where patients and their providers work together to make health care decisions Takes into account
best scientific evidence, as well as patient’s values and preferences Goal to provide patients the support they need to make the best decision for them
Gold Standard Approach!
Informed Medical Decisions Foundation
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Patient Considerations in Choosing A Method
EffectivenessSafetyEase of useHow to remember how to use itHow it works
How long it lastsPossible side effectsAbility to become pregnant after stopping the methodAbility to control the method Impact on periodAbility to keep method
private
Other
?
14Slide15
Patient-Centered Counseling: How to Start
What is important to you in a contraceptive method?
Possible responses:
Effectiveness
Safety
Ease of use
How to remember how to use it
How long it lasts
Possible side effects
Ability to become pregnant after stopping the method
Ability to control the method
Impact on period
Ability to keep method private
Other?
15Slide16
Birth Control Method Options Chart
Link:
http
://
fpntc.org/training-and-resources/birth-control-method-options-chart
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Meet Tina….
19 years old Visiting the clinic for STD screening Would you like to have children some day?Yes, but not for a couple of years, at least
What is important to you in a method?Effectiveness, “wouldn’t want any surprises”Not something to remember every dayWould prefer if period was lighter
17Slide18
Using the Birth Control Method Options Chart
Link:
http
://
fpntc.org/training-and-resources/birth-control-method-options-chart
18Slide19
Benefits of Shared Decision Making
By using a shared decision-making approach to counseling, the goal is that the patient is able to choose a method that will work best for them.
When patients obtain their method of choice, they are more likely to use it consistently and correctly, and have higher satisfaction and continuation rates.
Dehlendorf
C et al. Contraception
.
2017Gavin L et al. Providing Quality Family Planning Services. MMWR 2014
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Patient-Centered Counseling Sample Questions
Start with the question: “What is important to you in a method?”
Use counseling job aids to help patients identify methods that meet most (if not all) of their preferences. Use probe questions about characteristics:Some methods don’t have to be taken every day whereas others do have to be taken every day to work correctly. How would it be for you to take the method every day? Some methods are more effective at preventing pregnancy than others. How important is method effectiveness?
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Putting Patient-Centered Counseling into Practice
Use teaching aids, including visual aids and models of methods, that patients may not be familiar with (e.g., IUD and implant)
Present natural frequencies rather than percentagese.g., “less than 1 in 100 women get pregnant using the implant”Materials should be at the 4th-6th grade reading level21Slide22
FAQs About Shared Decision Making
Q. Does patient-centered counseling take more time than other forms of counseling?A. Many providers find that this approach actually takes less time because the conversation focuses on what is most important to the patient instead of trying to cover what
might be important. Q. How should we talk about method effectiveness?A. Method effectiveness is one method characteristic. Counselors should elicit preferences about effectiveness during counseling by asking “how important is method effectiveness to you?” Counselors can help patients identify methods that reflect this preference. For many patients, method effectiveness is very important, for others it may be less so.
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Quality Contraceptive Counseling and Education: A Client-Centered Conversation eLearning Course
5 Modules (2.5
hours)Foundations for Counseling and EducationBuilding Rapport and Communication SkillsQuality Education StrategiesInteractive Client-Centered Decision Making
Confirming Understanding and Supporting a Plan
Link
:
https
://fpntc.org/training-and-resources/quality-contraceptive-counseling-and-education-a-client-centered-conversation 23Slide24
Counseling Observation Checklist
L
ink:
http
://
www.cardeaservices.org/documents/Observational_Contraceptive_Counseling_Checklist.pdf
24Slide25
Interpersonal Quality Family Planning Scale
Think about your visit with [provider] today. How do you think they did? Please rate them on each of the following by circling a number.
Poor
Fair
Good
Very good
Excellent
Respecting me as a person
1
2
3
4
5
Letting me say what mattered to me about my birth control method
1
2
3
4
5
Taking my preferences about my birth control seriously
1
2
3
4
5
Giving me enough information to make the best decision about my birth control method
1
2
3
4
5
Dehlendorf
C et al.
Contraception
.
2017
25Slide26
Patient Education: Bedsider.org
26Slide27
Patient Education: Online Decision Support Tool
In ~10 minutes, walks patients through basics on contraceptive methods, with goal of helping patients identify their questions to ask providers about different methods
Link:
https://clinic.mybirthcontrol.org/
27Slide28
Patient Education: Explaining Contraception Handouts
Handout with details and characteristics available for each method
Link:
https://fpntc.org/sites/default/files/resource-library-files/TrainingTools-ExplainingContraception.pdf
28Slide29
Further Reading on Shared Decision Making
Dehlendorf C, Grumbach K, Schmittdiel
JA, Steinauer J. Corrigendum to "Shared decision making in contraceptive counseling" [Contraception (2017) 95:452-455]. Contraception. 2017 Sep 05. PMID: 28886761.Dehlendorf C, Anderson N, Vittinghoff E, Grumbach
K, Levy K,
Steinauer
J.
Quality and Content of Patient-Provider Communication About Contraception: Differences by Race/Ethnicity and Socioeconomic Status. Womens Health Issues. 2017 Sep - Oct; 27(5):530-538.
Dehlendorf C, Grumbach K, Schmittdiel JA, Steinauer J. Shared decision making in contraceptive counseling. Contraception. 2017 May; 95(5):452-455. PMID: 28069491.Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use
.
Clin
Obstet
Gynecol
2014; 57(4): 659-73.
Dehlendorf
C, Levy K, Kelley A,
Grumbach
K,
Steinauer
J.
Women's preferences for contraceptive counseling and decision making
.
Contraception
2013; 88(2): 250-6.
Higgins JA.
Celebration meets caution: LARC's boons, potential busts, and the benefits of a reproductive justice approach
.
Contraception
2014; 89(4): 237-41.
29Slide30
Success Story: Standard Messages and Documentation (AZ Family Health Partnership)
Reproductive life planning training for providers including
Overview of reproductive life planningHow to document in EHRStandardized messaging 2 months later, 80% of female patients had documented reproductive life plan, up from 50%Key points: Standardizing messaging and reviewing documentation are important aspects of provider training.
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Success Story: Engaging All Staff
(NJ Family Planning League)Reproductive life planning training for providers includingFor all staff, including Front Desk staff
Provided opportunity for staff to practice new skills in assessing for reproductive intention Chart audit showed that 90% of patients had reproductive life plan documented after staff trainingKey point: Engage all staff and provide an opportunity for staff to practice new skills in training.
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What other questions do you have?
What other issues would you like to discuss?
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Thank you!
Contact:fpntc@jsi.com
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