claudine offer, mph barbara kass, rnpcp, msn maryjane puffer, bsn, mpa kathryn horsley, drph

33
PRECONCEPTION CARE INTEGRATION WITHIN FAMILY PLANNING SERVICES: EXPLORING THE CLIENT AND PROVIDER EXPERIENCE Claudine Offer, MPH Barbara Kass, RNPCP, MSN Maryjane Puffer, BSN, MPA Kathryn Horsley, DrPH 3rd National Summit on Preconception Health and Health Care June 13, 2011

Upload: armina

Post on 24-Feb-2016

25 views

Category:

Documents


0 download

DESCRIPTION

Preconception care integration within family planning services: Exploring the client and provider experience. Claudine Offer, MPH Barbara Kass, RNPCP, MSN Maryjane Puffer, BSN, MPA Kathryn Horsley, DrPH. Introduction. California Family Health Council - PowerPoint PPT Presentation

TRANSCRIPT

Preconception Evaluation Project

Preconception care integration within family planning services:Exploring the client and provider experienceClaudine Offer, MPHBarbara Kass, RNPCP, MSNMaryjane Puffer, BSN, MPAKathryn Horsley, DrPH3rd National Summit on Preconception Health and Health CareJune 13, 2011Explain: We trained providers to provide preconception messages in FP visits and then collected information on how clients and clinicians felt about the integration.1June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.IntroductionCalifornia Family Health CouncilDistributes federal Title X family planning funds to 80 community agencies (347 clinic sites) throughout California serving over 1.2 million clients annuallyPerforms advanced research in reproductive health and contraceptionConducts education, training, and community outreachImplements and monitors effective community health programs

To beginId like to tell you a little bit about our organization. The CaliforniaDefine Title X: federal funding for the national family planning program, Title X of the Public Health Service Act2June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Why preconception care in family planning?Family planning clients:In reproductive yearsSeeking health care services Title X clients:Low incomeHigh rates of poor birth outcomes

Approximately 70% of the activities cited in the CDC MMWR on preconception care are provided in family planning settingsFP clients: Seeking health care services point of contact for opportunistic intervention. Title X clients are family planning clients with additional characteristics that make PCC intervention ideal.Often this is the only opportunity for health care services and pcc messages.CDC Morbidity and Mortality Weekly Report

3June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Preconception Care and Intention for PregnancyIn the U.S. 49% of all pregnancies and 82% of teen pregnancies are unplanned (Finer & Henshaw, 2006)In the U.S. 48% of unintended pregnancies occur among women who were using a contraceptive method at the time they conceived (Finer & Henshaw, 2006)Preconception care messages have potential to:Improve womens health and birth outcomes regardless of intention for pregnancyImprove womens health regardless of eventual pregnancyId like to address the issue of intention for pregnancy among family planning clients. Issue of client centered approach and also will be a consideration as we explore the results of the project. Title X services reach women who have both planned and unplanned pregnancies

This also makes FP/TX setting ideal

6 Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual & Reproductive Health 2006; 38(2):90-96.

California Family Health Council, Inc.June 13, 20113rd National Summit on Preconception Health and Health Care4

Project DescriptionOrientation of clinic site staffReview of health history form and client chartFour screening questions: Do you want to get pregnant? If so, when? Are you sexually active (at risk for pregnancy)? If so, are you trying to prevent pregnancy (and how)? 5June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Providers were asked to integrate core preconception messages in family planning visits:

Folic acid intakeDiabetesObesitySubstance use

Project DescriptionDefine FP visits: birth control, annual, breast exam, pap and pap f/up, pregnancy test, std/hiv testing and resultsThese five issues prioritized as part of project and evaluation. At least one issue addressedbased on review of health history and chartIntervention was provided over six month period. Varied by site.

6June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Preconception Integration Clinic SitesClinic sites2 Los Angeles sites, 1 San Francisco siteInterest in preconception integrationSufficient family planning visits for recruitment7June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Evaluation QuestionsClients attitudes about receiving preconception care messages in family planning visitsClients intentions for health behavior changes related to core preconception messagesProviders experiences integrating preconception care messages into family planning visitsWe wanted information on these three areas. We saw promising responses to all of these as you will see when we look at results.8June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Data SourcesClient post-visit surveyCompleted after family planning visitIntervention logProviders recorded types of preconception messages, method of intervention, and time spentPost project interview/surveyProviders experience with process and continued integrationClient survey: one site offered $5 gift cards as incentives9June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Providers and ParticipantsProviders10 clinicians, 1 health educatorParticipantsFemaleFamily planning visitAges 13 45n = 555

Explain health educator format for 1 clinic site. Limited info on provider integration but adequate info from clients10June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Sample Population Survey LanguageSurveys CompletedPercentEnglish33059%Spanish22541%n = 555Determined by which version of survey was completed.12June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.RaceAgeMean Age = 27.2n = 552Representative of Title X agencies, 54% of respondents were between 20-29

California Family Health Council, Inc.June 13, 20113rd National Summit on Preconception Health and Health Care14Reason for Visitn = 549ResultsThese first two results summarize the intervention .The following results will provide answers to our evaluation questions.16June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Type of Intervention ProvidedNote: Because providers could select multiple response options, percentages add up to greater than 100%n = 555Provider response. Interv not mutually exclusive. Many women received both verbal interventions as well as handouts.17June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Time Spent on Preconception Care n = 543Data Source: Provider Intervention LogProvider reported on intervention log. PCC interventions not timed. Providers estimatedlimited accuracy.18June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Intention for PregnancyIntend Future PregnancyFrequencyPercentYes44082%No9217%Dont Know81%n = 540Some clients may have opted out if no desire for pregnancy. Possibly not representative of Title X clients.Greatest desire among age group 20-29. We did not gather information on # of previous pregnancies. DK was not option on survey.19June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Timeframe forIntended PregnancyTimeframeFrequencyPercent< 1yr9422%2-4 yrs14633%> 5 yrs11426%DK8419%n = 43855% of women who desire a pregnancy would like to be pregnant within 4 years

20June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Timeframe for Pregnancy by RaceRace< 1 yr2-4yrs> 5yrsLatina31%40%29%Asian23%29%48%White7%41%52% p = .0023 n = 300 * Cumulative21June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Client Acceptance of Preconception Messages97% strongly agreed or agreed that information about how women can prepare for healthy pregnancies should be offered to women during their family planning visits (n=527, mean 4.7)94% strongly agreed or agreed that they were interested in the information they received during their visit about how they can have a healthy pregnancy (n=486, mean 4.5)

Likert scale 1-5No desire for baby means: Acceptance 4.6, Interest 4.3 (n=83, 67)An important finding that women are receptive to PCC in the context of FP visits and reaffirms Title X role in the provision of preconception care services and health education.

22June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Intention to Make Health Behavior Changes86% of respondents stated that they were interested in making at least one change (n=524)70% of respondents thought they would make changes within 3 months (n=503)PAUSE: stress that here we begin to explore the answers to our evaluation questions.These results are for all women responding regardless of desire for pregnancy23June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Change and Preconception IssuesPreconception Health IssuePercent of Clients Desire Change*Folic acid61%Healthy foods55%Exercise52%Weight42%Smoking8%Alcohol7%n = 451* Among those intending at least one changeRegardless of desire for pregnancy.24June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Change and Preconception IssuesPreconception IssuePercent of Clients Desire Change*n Weight72%n = 187Folic acid70%n = 349Smoking15%n = 167Alcohol14%n = 173Drugs10%n =72* Among those who recalled specific intervention messageRegardless of desire for pregnancy.Healthy Food 45%, Exercise 42%, n = 555 These two items were not provided in Q5 pcc issues recalled. I can not include in analysis of change desired among those who recalled message. However, responses (desire for change) among all participants (n=555) was high so we might conclude that desire for change would have been even higher (as we saw with other results) if we could have limited analysis to those who recalled/rec'd message. California Family Health Council, Inc.June 13, 20113rd National Summit on Preconception Health and Health Care25Desire for Changeby Intent for Pregnancy Desire ChangeNoChangeIntend Pregnancy88%12%Do Not Intend Pregnancy76%24%p < .0051n = 502Desire for change is high among both groups. Perhaps women who dont desire pregnancy recognize value of these general health issues.. Intention for a pregnancy was not associated with the timeframe of making any health changes

26June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Desire for Change byTimeframe for PregnancyDesire changeDo Not Desire Change< 1 year99%1%2-4 years90%10%> 5 years82%18%p = .0004n= 346In a previous slide we saw that 55% of those wanting a pregnancy desired a pregnancy within 4 years. Timeframe associated with desire for change. Highlight as important outcome for guiding intervention development. Theory of health behavior change could be applied.

Among those who desire a pregnancygreater interest in making changes associated with timeframe of pregnancy. Greater if pregnancy desired sooner. On one hand this means interventions could be focused on those who desire pregnancy within 1 yr, or 3 years. But, then unplanned pregnancies may not be prepared for. Timeframe of pregnancy and timeframe of changesno association.

27June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Provider ExperienceProvider themesSupportive of preconception integrationPerception that clients welcome preconception messagesConcern about additional burden of integrationIncreased ease with preconception care implementation over timeIdentified need for more appropriate materialsn = 8Post-project interview, emergent themes summarized here. Materials: low-literacy, Spanish, etc.Feedback on implementationthere were also comments about the impact of evaluation. Log was too complex and time consuming, clients not wanting to complete survey. Impact of preconception intervention vs. the evaluation component. Not all providers were able to attend.28June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.ConclusionsFamily planning clients were receptive to preconception messagesFamily planning clients were interested in making health behavior changes after hearing preconception messagesInterest in making changes was associated with desire for pregnancy and timeframe of desired pregnancyContinued 29June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Providers estimated that identification and provision of most interventions took an estimated 1-3 minutesProviders were supportive of preconception integration but had concerns about time and burden

Conclusions California Family Health Council, Inc.June 13, 20113rd National Summit on Preconception Health and Health Care30RecommendationsDevelop preconception interventions that address intention and timeframe of pregnancyDevelop protocols and guidelines for family planning providersProvide training for family planning providers and clinic administratorsAdd screening questions including intention for pregnancy and timeframe in health history forms and EHR (Electronic Health Record) systemsConduct additional, larger scale preconception intervention studies2nd point: client fact sheets, health history formsthings that simplify intervention delivery reduce burden on providers and make integration more feasible for busy providers

31June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.AcknowledgementsTitle X Family Planning ClientsSan Francisco Department of Public HealthMaxine Hall Health CenterLos Angeles County Department of Health ServicesHarbor UCLA Womens Health Care ClinicNortheast Valley Health CorporationSan Fernando Health CenterMarch of Dimes

32June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.Claudine Offer, MPHProgram Evaluation ManagerCalifornia Family Health Council 2550 Ninth Street, Suite 110Berkeley, CA 94710phone: 510-486-0412 Ext. 2333email: [email protected]: www.cfhc.org

Please contact me if you have any questions about the integration project or the evaluation.33June 13, 20113rd National Summit on Preconception Health and Health CareCalifornia Family Health Council, Inc.