Barriers to Interconception Care Delivery in Primary Care: Clinician, Staff, and Patient Perspectives.

Abstract

Purpose: Many reproductive age women, cared for routinely by primary care providers (PCPs), would benefit from interconception care, yet a minority of primary care visits include interconception care. This study assessed barriers to providing interconception care from the perspective of primary care clinicians, staff, and patients.

Materials and methods: Clinicians (n = 11), staff (n = 14), and patients eligible for interconception care (n = 6) from three primary care clinics in Chicago, Illinois participated in focus groups or interviews. Sessions with clinicians and staff elicited descriptions of their clinic's current care delivery processes; sessions with patients focused on their experiences accessing care following pregnancy. Data were used to produce a process map and to identify barriers and facilitators to providing interconception care. Sessions were audio-recorded, transcribed, and thematically analyzed using Dedoose. Findings on barriers are presented here.

Results: Processes for clinics to identify patients eligible for interconception care are lacking. PCPs do not routinely receive information about their patients' prior pregnancies, and relevant information can be hard to access. While patients describe many care needs between pregnancies, they are unsure of where to turn for help: their PCP, obstetrical clinician, or other sources. Contributing organizational limitations involve clinic structure, appointment availability, resources, and insurance coverage.

Conclusions: Multiple barriers in current primary care systems and processes contribute to poor interconception care delivery. These findings, given the known benefits of interconception care, can inform human-centered design to overcome barriers.