Improving documentation rates of contraception and reproductive planning in rheumatic disease patients.

Objectives: This study aimed to improve contraception and reproductive planning documentation within rheumatology providers' notes at a single academic center.

Methods: Female patients aged 18-45 years old with autoimmune inflammatory rheumatic diseases were identified and chart review was performed for documentation of contraception and pregnancy planning. Baseline data were collected from 148 charts between May 2022 and March 2023. In June 2023, a reproductive health assessment questionnaire was integrated into the electronic health record and sent to patients for completion prior to their visits. Post intervention data was collected from 176 charts between July 2023 and December 2023. Demographics of patients (race, ethnicity, gender) and provider gender were collected. Telehealth and face to face visits were assessed separately.

Results: A statistically significant increase (p<0.0001) was seen in provider documentation of both contraception (44.6% to 70.5%) and pregnancy planning (15.5% to 60.2%) after implementation of the pre-visit questionnaire. When patients prescribed teratogenic medications were analyzed separately, there was statistically significant (p<0.0001) better documentation of pregnancy planning after the intervention. Secondary analyses found that patient age, race/ethnicity, encounter type, or provider gender had no significant impact on documentation rates.

Conclusions: By integrating an electronic, pre-visit questionnaire into the patient portal, documentation was significantly improved for contraception and pregnancy planning. The results were sustained for 6 months. Further studies are needed to see if improved documentation translates into more effective reproductive health care discussions, referrals to gynecology, and subsequent improvement in reproductive health outcomes.