2015 APHA Annual Meeting & Expo

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Online Program

321899
Understanding and addressing system-level barriers that compromise teens' equal access to contraceptive care in an urban safety net health care system


Monday, November 2, 2015

Jennifer Carmona, MPH, Office of Population Health, New York City Health and Hospitals Corporation, New York, NY
Elet Howe, MPH, Office of Population Health, New York City Health & Hospitals Corporation, New York, NY
Richard Zapata, Office of Population Health, New York City Health & Hospitals Corporation, New York, NY
Susan Kansagra, MD, MBA, New York City Health & Hospitals Corporation, New York, NY
Deadra Caleb, Office of Population Health, New York City Health & Hospitals Corporation, New York, NY
Machelle Allen, MD, Office of Medical and Professional Affairs, New York City Health and Hospitals Corporation, New York, NY
The New York City Health and Hospitals Corporation (HHC) is the country’s largest public hospital system, providing primary care services to nearly 50,000 adolescents annually.  HHC’s Adolescent Health Program (AHP) is working to ensure that teens’ needs for sexual and reproductive health care (SRH) services are met.  To rate teens’ access to contraceptive care at HHC’s facilities, AHP developed a scorecard.

AHP team members visited 14 sites over five months using a qualitative rating system to score facilities across three domains:  1)  access to prescriptions for contraception in pediatric primary care;  2)  access to emergency contraception (EC) in pediatric primary care;  and 3)  access to long-acting reversible contraception (LARC) in gynecology and family planning clinics.  Over 1/3 (36%) received top ratings (“A”) for providing contraception prescriptions and 43% received top ratings for providing EC.  No facility received top ratings for LARC access (providing same-day insertion on-site) but 36% received “B” ratings.  No facility received top ratings in all three domains. 

Measuring performance both revealed barriers to full access and motivated initial improvement efforts.  Barriers included providers’ attitudes about contraceptive care guidelines for teens (71%), policies preventing distribution of EC in clinics (29%), and lack of LARC on site (21%).  After reviewing ratings, two facilities started dispensing EC in the clinic so that 57% received top ratings in that domain.  AHP is working with facilities to develop additional strategies for improving teens’ access to contraceptive care and will repeat the measurement of access along the same domains.

Learning Areas:

Administration, management, leadership
Program planning
Provision of health care to the public

Learning Objectives:
Compare clinics' performance in providing contraceptive care for teens using a qualitative rating system Identify key system level barriers to providing comprehensive contraceptive care to teens Assess strategies for improving teens' access to contraceptive care using a quality improvement framework

Keyword(s): Adolescents, Accessibility

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in the field of public health for 10 years in a variety of roles to improve the quality of care for adolescents. Most recently I’ve joined the Adolescent Health Program team, a New York City funded program to improve quality and access of the adolescent population of the public hospital system, with an emphasis on improving access to contraception for teens.
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.

Back to: 3217.0: Contraception