Initiating the Conversation: Prioritizing Women's Reproductive Health in Primary Care.

Background: The United States continues to have the highest rates of maternal mortality and morbidity of all high-income countries. Added to this is the high rate of unintended pregnancy, making it clear that reproductive health services in this country are still deficient. National health care organizations recommend prioritizing reproductive health in primary care.

Methods: Using the knowledge-to-action framework, this quality improvement project applied evidence-based practice regarding preconception and contraceptive services to primary care. King's Goal Attainment Theory was used to disrupt the usual routine and create a culture promoting reproductive health conversations with patients. Staff received education on reproductive health in the primary care setting, leading to the development of a new process to screen for pregnancy intent. Providers were guided on the use of shared decision-making tools to discuss reproductive services and to provide preconception care and the full range of contraceptive methods.

Results: Over 40% of female patients seen received unexpected yet desired reproductive health services. Providers and staff reported that the implementation of the process was feasible and sustainable. A new culture emerged in which reproductive health inquiry became usual care.

Conclusions: Including reproductive health inquiry as part of the primary care visit was an easy intervention to implement that led to success in bridging the gap to reproductive health in primary care without placing undue burden on providers or staff.