Jefferson Healthcare: A Model for Patient-Centered Contraceptive Care

Jefferson Healthcare and Upstream USA have partnered to expand local access to contraceptive care. Upstream works with healthcare systems to strengthen the provision of reproductive care.  They support system changes to ensure equitable access to contraceptive options into the clinical daily routine. Patient-centered contraceptive care is at the core of our partnership; we share a commitment to preventive care and understand reproductive care is essential to a person’s long-term health and well-being. As a result of the collaboration, Jefferson Healthcare is increasing access to our patients’ preferred birth control options, both in primary care and immediately postpartum.

With five standalone primary care clinics, an OB/GYN clinic, and a birth center, Jefferson Healthcare is a model for reducing barriers to family planning, reproductive and contraceptive care and providing comprehensive health services to its community.

Contraceptive Care is Preventive Care

Upstream evaluated current protocols and consulted on opportunities to improve workflows and contraception availability.   Jefferson Healthcare staff enrolled in training sessions which spanned updates on contraceptive methods, avoiding reproductive bias, skills development on method provision, and use of patient education tools.  Their team met with peer-to-peer coaches from the clinics and discussed tactics for sustainable practice change. Upstream staff were impressed by the dedication of Jefferson Healthcare staff to centering patients, helping patients understand their options and make individualized decisions. Dr. Molly Parker, Chief Medical Officer for the Population Health Department at Jefferson Healthcare, explained, “Choosing when to create a family is crucial. It can be devastating when it doesn’t happen at the right time.”

In response to Upstream recommendations, primary care teams incorporated asking all patients of reproductive age a “pregnancy intention screening question (PISQ)” at any visit.  Asking, “Do you plan to start a family in the next year?” or “Are you planning a pregnancy?” creates an opportunity for dialog to support patient goals.

During a recent two-day visit, Upstream representatives spoke with staff and providers at Jefferson Healthcare about their challenges and successes in improving equitable access to contraceptive care. Their on-site observations lead to further changes including a means to better support uninsured patients access to contraceptive methods.

Dr. Parker credits the program with improving internal systems, making them more consistent, and providing higher access to birth control. “It sounded intriguing,” she said. “Part of the problem in primary care, and medicine anywhere, is that people come in with an urgent need, and that’s what we focus on. We don’t always get a chance to talk about big-picture life goals. Working with Upstream helped us create systems to ensure we’re regularly checking in on those needs. Contraceptive care may not feel like a fire at the moment of the visit but it can play a big role in your health and is worth discussion.”

A shared decision-making approach leads to conversations about reproductive goals, and providers have an opportunity to deliver patient-centered, individualized counseling. Here are just a few examples of how the discussions have gone:

• “A patient came in and was on a contraceptive injection but was having some unenjoyable side effects. I talked with her, and she wanted to try an implant. I was so excited – I had just gone through the Upstream training and was able to offer her this option same-day.” – Health Center NP
• “One of the first times I asked a patient the PISQ, it was a man in his 30s, and he said he actually had been wanting a vasectomy for some time but wasn’t sure who to ask or where to go. I was able to connect them with our provider and get an appointment on the books for him to come in for a vasectomy.” – Health Center MA
• “A patient came in and already had an IUD. I asked them if it was still working well for them, and they said, ‘Actually, I’ve been wanting to get my tubes tied but just haven’t been able to bring it up.’” – Health Center Peer-to-Peer Coach

By incorporating the pregnancy intention screening question into our practices, we create opportunities for patients to talk with their providers about their reproductive goals. At your next primary care visit, we’ll invite you to prioritize preventative care and take charge of your reproductive health.