Patient-Centered Care of Women Includes Reproductive Health

Because reproductive health is a big part of patient-centered care for women of reproductive age, NCQA recently convened a summit of 17 researchers to discuss a perplexing question: Why do so few women use long-acting reversible contraceptives (LARC)?

LARCs, including intrauterine devices and birth control implants, are highly effective. Yet the CDC reports that only 7.2 percent of American women use this form of contraception. That low utilization stands in troubling contrast to high rates of unintended pregnancy in the United States.

Summit attendees identified five barriers that keep women from choosing LARCs. As you read the list, consider if your practice contributes to these patterns:

  1. Operational/Process Issues: Primary care providers often do not stock LARCs in their offices because of high upfront costs. This means same-day placement of a LARC is often difficult to obtain, presenting an inconvenient delay for patients. Health plan reimbursement reform could resolve this issue.
  2. When the Message is Delivered: Doctors often talk to women about their choice of contraceptive too late. Many mothers of newborns do not attend their 6-week postpartum visit, the customary time to discuss optimal spacing of births and to prescribe appropriate contraception.
  3. Lack of Quality Measure: Not enough data are collected to support a robust measure that could motivate change in clinical practice. An alternative approach is to consider family planning a “vital sign” that would add a contraception measure to those collected at during annual patient evaluations. This approach would lead to stronger evidence for effecting change.
  4. Current Counseling Approach: Doctors who discuss contraception with women don’t fully explain benefits and dangers, a shortcoming that can thwart serious consideration of LARCs.
  5. Message Delivery and Understanding: The value-based approach to health care increasingly places patients’ reproductive care responsibilities with their primary care provider, rather than with an OB/GYN. Contraceptive counseling and family planning discussions should be strengthened in primary care training.

Click here for more information and to download a brief that outlines barriers and possible solutions to these problems.

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