Improving Contraceptive Care for Women With Medical Conditions
Study Details
Study Description
Brief Summary
The purpose of this project is to describe how contraceptive services are currently being delivered to women with medical conditions who seek care in community-based primary care settings, such as family medicine and internal medicine clinical offices.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
This pilot study seeks to:
- To understand women's beliefs, attitudes, and experiences with contraception in context of their medical conditions, drug therapy, personal preferences, and current experiences in primary care.
- To describe provider- To describe provider- and practice-level factors that impact the delivery of contraceptive services in primary care.
To seek the perspectives of multiple stakeholders: 1) women aged 18-50 with one or more medical conditions; and 2) practice members who consist of primary care providers (PCPs) and office staff (e.g. nurses, medical assistants, and administrative staff members). The specific objective of this formative, qualitative study is to identify key patient-, provider-, and practice-level factors that are critical to the delivery of contraceptive counseling and services to women with medical conditions.
To accomplish these aims, qualitative data will be collected in clinical settings that currently provide primary care and family planning for reproductive-aged women with medical conditions. Data collected will be: 1) in-depth interviews with women with medical conditions and practice members; and 2) semi-structured observations of office activities and processes (e.g. patient check in, patient scheduling).
Using rigorous qualitative mixed methods to collect and analyze data, a deeper understanding will be gained of factors that should be considered in the design and implementation of future interventions to improve contraceptive care for women with medical conditions in primary care.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Patients Women with chronic medical conditions |
Behavioral: Interview
1 hour semi-structured
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Primary Care Providers and Medical Staff Primary care providers can include doctors and advanced practice professionals, including midwives, nurse practitioners, and physician assistants. Medical staff can include social workers, nurses, medical assistants, and administrative staff |
Behavioral: Interview
1 hour semi-structured
|
Primary Practice Primary care practices (family medicine, internal medicine, medicine-pediatric, or any combination of these) that at a practice-level already provide contraceptive counseling and services to reproductive-age women |
Behavioral: Observation
Field Observation
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Outcome Measures
Primary Outcome Measures
- Factors To Guide the Design of Contraceptive Design Application [6 months]
A semi-structured interview will be used to identify patient-, provider- and practice-level factors that are relevant to the design and implementation of a contraceptive decision aid.
Eligibility Criteria
Criteria
Patients:
To be eligible for the study, the patient must meet all the following criteria:
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Able to speak English
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Able to give informed consent
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Have at least one significant medical condition (defined as any condition that requires medication management and/or active monitoring, like hypertension, diabetes) that would pose greater than average risk to the woman during pregnancy, including the use of medications that could be associated with potential fetal harm in the event of unplanned pregnancy (defined as medications that are Pregnancy Category C, D, or X).
Exclusion Criteria:
Patients who meet any of the following criteria will be excluded:
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surgically or medically sterile or whose current male partner(s) are surgically or medically sterile
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females under 18 years are excluded because prior literature has shown that their healthcare and pregnancy-related experiences differ substantially enough from those of adult women.
Practice Members Inclusion Criteria:
To be eligible for the study, the practice member must meet all the following criteria:
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Age 18 or older
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Able to speak English
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Able to give informed consent
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Indirectly or directly involved with patient care
Primary Practices:
To be eligible for the study, primary care practices must meet all the following criteria:
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currently provide primary care services to reproductive-aged women aged 18-45
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currently provide prescriptions for birth control and/or provide insertion/removal of contraceptive devices (the intrauterine device or sub-dermal implant) on site OR refer patients to another site.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Department of Family Medicine | Ann Arbor | Michigan | United States | 48104 |
Sponsors and Collaborators
- University of Michigan
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
- Principal Investigator: Justine P WU, MD, University of Michigan
Study Documents (Full-Text)
None provided.More Information
Publications
- Akers AY, Gold MA, Borrero S, Santucci A, Schwarz EB. Providers' perspectives on challenges to contraceptive counseling in primary care settings. J Womens Health (Larchmt). 2010 Jun;19(6):1163-70. doi: 10.1089/jwh.2009.1735.
- Chor J, Rankin K, Harwood B, Handler A. Unintended pregnancy and postpartum contraceptive use in women with and without chronic medical disease who experienced a live birth. Contraception. 2011 Jul;84(1):57-63. doi: 10.1016/j.contraception.2010.11.018. Epub 2011 Jan 20.
- Crabtree BF, Miller WL. A qualitative approach to primary care research: the long interview. Fam Med. 1991 Feb;23(2):145-51. Review.
- Curtis KM, Tepper NK, Jamieson DJ, Marchbanks PA. Adaptation of the World Health Organization's Selected Practice Recommendations for Contraceptive Use for the United States. Contraception. 2013 May;87(5):513-6. doi: 10.1016/j.contraception.2012.08.024. Epub 2012 Oct 4.
- Dehlendorf C, Levy K, Ruskin R, Steinauer J. Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care? Contraception. 2010 Apr;81(4):292-8. doi: 10.1016/j.contraception.2009.11.006. Epub 2009 Dec 11.
- DeNoble AE, Hall KS, Xu X, Zochowski MK, Piehl K, Dalton VK. Receipt of prescription contraception by commercially insured women with chronic medical conditions. Obstet Gynecol. 2014 Jun;123(6):1213-1220. doi: 10.1097/AOG.0000000000000279.
- Dicicco-Bloom B, Crabtree BF. The qualitative research interview. Med Educ. 2006 Apr;40(4):314-21. Review.
- Lee JK, Parisi SM, Akers AY, Borrero S, Schwarz EB. The impact of contraceptive counseling in primary care on contraceptive use. J Gen Intern Med. 2011 Jul;26(7):731-6. doi: 10.1007/s11606-011-1647-3. Erratum in: J Gen Intern Med. 2011 Jul;26(7):822. Borrerro, Sonya [corrected to Borrero, Sonya].
- Ornstein SM, Nietert PJ, Jenkins RG, Litvin CB. The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report. J Am Board Fam Med. 2013 Sep-Oct;26(5):518-24. doi: 10.3122/jabfm.2013.05.130012.
- HUM0012060
- 1K23HD084744-01A1