142nd APHA Annual Meeting and Exposition

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Quality of reproductive health care of primary care providers

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Heike Thiel de Bocanegra, Ph.D., M.P.H. , Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Sacramento, CA
Leslie Watts, MS , Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Sacramento, CA
Fran Maguire , Bixby Center for Global Reproductive Health, Department of Gynecology, Obstetrics and Reproductive Sciences, University of California, San Francisco, Sacramento
Richard Chang, MPH , Bixby Center for Global Reproducitve Health, Department of Gynecology, Obstetrics, adn Reproductive Sciences, University of California, San Francisco, Sacramento, CA
Philip Darney, MD, MSc , Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
With the implementation of the Affordable Care Act (ACA), an increasing number of men and women in need of family planning services will have access to primary care providers. California’s Medicaid family planning expansion, Family PACT, has a network of over 2,000 clinician providers, who agree to adhere to reproductive health program standards. Nearly two-thirds of Family PACT providers are primary care/multispecialty clinics (PC/MS) and 37% are family planning/women’s health clinics (FP/WH). We analyzed quality indicators from a 2011 medical record review of 2,983 Family PACT visits to determine the differences in reproductive health service delivery by provider specialty. 

Percentages of clients who had contraception as the stated reason for the visit and received counseling on contraception or sexually transmitted infection were similar for FP/WH and PC/MS clinics. Clients seen by PC/MS providers had a higher percentage of counseling on chronic or acute disease management (12%) and smoking cessation (8%) than those seen by FP/WH providers (8% and 4%, respectively). A significantly higher percentage of PC/MS providers (69%) documented sexual history compared to FP/WH specialists (62%). 

Compared to clients served by PC/MS providers, female clients served by FP/WH specialists were more likely to rely on highly effective contraceptive methods such as intrauterine devices and implants (p<0.0001) and less likely to leave with no method or to be pregnant or seeking pregnancy (p<0.05) at the end of the abstracted visit.  PC/MS providers were more likely than FP/WH specialists to refer women with a positive pregnancy test for prenatal counseling (70% versus 48%), whereas FP/WH were more likely than PC/MS providers to document pregnancy related counseling (24% versus 14%) and referrals for abortions (31% versus 9%). 

While the percent of clients having contraception as the reason for the visit and receiving contraceptive counseling were similar for primary care and family planning providers enrolled in the Family PACT program, we found differences in quality of documentation, provision of highly effective contraception, type of counseling after a positive pregnancy test, and counseling on acute and chronic disease management in the context of a family planning visit. These differences could influence patients’ ability to prevent unintended pregnancies. As an increasing number of women and men gain access to reproductive health services due to ACA, policymakers and program administrators need to monitor the quality of sexual reproductive health services of primary care providers.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
List five indicators that measure quality of reproductive health services Identify three differences in reproductive health counseling and sexual history taking between family planning/women’s health providers and primary care/multispecialty providers Discuss differences in the choice of contraceptive methods of clients seen by primary care/multispecialty and clients seen by family planning/women health providers.  

Keyword(s): Family Planning, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have work in public health programs and health service resaerch for over 20 years. My doctoral degree is in International Community Health Education.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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