Changes in contraceptive services during a statewide initiative to expand patient-centered contraceptive care in Massachusetts

Abstract

Objectives

To evaluate how access to and quality of contraceptive care changed among health centers supported by Upstream USA during a statewide contraceptive access initiative in Massachusetts.

Study design

Our mixed-method study reported on 12 health centers that encompass 63 sites, annually serving 72,225 patients of reproductive age (assigned female at birth, ages 15–44). We examined contraceptive care metrics extracted from electronic health records (EHR) to identify trends in reproductive health screening and contraceptive service provision before and after the intervention. We assessed the quality of contraceptive care through a post visit patient experience survey. Further insights from qualitative implementation reports were integrated to contextualize observed outcomes.

Results

All health centers increased EHR documentation of screening for contraceptive need, and we observed an increase in the provision of contraceptive services from 8.2 to 14.3 per 100 patients of reproductive age. Service rates increased across all method types except for emergency contraception. Service provision increased across sites within health centers, indicating expanded points-of-access for patients. Patient-reported outcome measures indicate high levels of autonomy in method choice during the visit and patient-centeredness of counseling. Factors critical to sustaining practice change included EHR-embedded screening questions, on-site coaching on workflow, using real-time data feedback loops, and securing leadership support for the integration of contraceptive care into routine primary care.

Conclusions

Findings from this study provide empirical evidence of the impact of key interventions of a statewide contraceptive access initiative to expand access to patient-centered contraceptive care within the primary care setting of community health centers.

Implications

This study demonstrated that embedding screening–based contraceptive care workflows into primary care and providing training and technical assistance to strengthen clinic capacity for the provision of all contraceptive method types are feasible strategies that can be used to expand access to high-quality, noncoercive, patient-centered contraceptive care at community health centers.