Open AccessPregnancy Intention Screening in Patients With Systemic Rheumatic Diseases: Pilot Testing a Standardized Assessment Tool
Author(s) -
Pryor Katherine P.,
Albert Bill,
Desai Sonali,
Ritter Susan Y.,
Tarter Laura,
Coblyn Jonathan,
Bermas Bonnie L.,
Santacroce Leah M.,
Dutton Caryn,
Braaten Kari P.,
Pace Lydia E.,
Rexrode Kathryn,
Janiak Elizabeth,
Feldman Candace H.
Publication year - 2022
Publication title -
acr open rheumatology
Language(s) - English
Resource type - Journals
ISSN - 2578-5745
DOI - 10.1002/acr2.11449
Subject(s) - medicine , pregnancy , referral , odds ratio , confidence interval , reproductive medicine , obstetrics , family medicine , reproductive health , obstetrics and gynaecology , physical therapy , gynecology , population , genetics , biology , environmental health
Objective Systemic rheumatic conditions affect reproductive‐aged patients and often require potentially teratogenic medications. We assessed the feasibility and impact of a standardized pregnancy intention screening question (One Key Question [OKQ]) in a large academic rheumatology practice. Methods This 6‐month pilot quality improvement initiative prompted rheumatologists to ask female patients aged 18 to 49 years about their pregnancy intentions using OKQ. We administered surveys to assess rheumatologists’ barriers to and comfort with reproductive health issues. We performed chart reviews to assess uptake and impact on documentation, comparing charts with OKQ documented with 100 randomly selected charts eligible for pregnancy intention screening but without OKQ documented. Results When we compared 32 of 43 preimplementation responses with 29 of 41 postimplementation responses, the proportion of rheumatologists who reported they were very comfortable with assessing their patients’ reproductive goals increased (31%‐38%) and the proportion reporting obstetrics and gynecology (OB/GYN) referral challenges as barriers to discussing reproductive goals decreased (41%‐21%). During the implementation period, 83 of 957 (9%) eligible patients had OKQ documented in their chart. Female providers were more likely to screen than male providers (odds ratio 2.42, 95% confidence interval 1.21‐4.85). Screened patients were more likely to have their contraceptive method documented ( P < 0.001) and more likely to have been referred to OB/GYN for follow‐up ( P = 0.003) compared with patients who were not screened with OKQ. Conclusion Although uptake was low, this tool improved provider comfort with assessing reproductive goals, the quality of documentation, and the likelihood of OB/GYN referral. Future studies should examine whether automated medical record alerts to prompt screening increase uptake.