Increasing Contraceptive Prescriptions in Adolescent Females With Documented Interest in Contraception: A Quality Improvement Project

Abstract

Background: Adolescent pregnancy is a significant cause of morbidity and mortality among women and infants. Timely and comprehensive reproductive care in the medical home is essential in preventing unintended adolescent pregnancy.

Methods: This quality improvement (QI) project was completed within the Division of Primary Care Pediatrics at Nationwide Children's Hospital in Columbus, a large pediatric quaternary medical center. The population included female patients 15 to 17 years old from predominantly medically underserved communities receiving well care at 14 urban primary care sites. We identified 4 key drivers: 1) electronic health record, 2) provider training, 3) patient access, and 4) provider buy-in. The outcome measure of this QI project was the percentage of female patients 15 to 17 years old who received a contraceptive prescription within 14 days of answering "yes" to interest in starting contraception at a well-care visit.

Results: Female patients 15 to 17 years old with an interest in contraception documented increased from 20% to 76%. Etonogestrel subdermal implant placement plus referrals to the BC4Teens clinic increased from 28/month to 32/month. Females 15 to 17 years old interested in contraception who received contraception within 14 days of a visit increased from 50% to 70%.

Conclusions: With this QI project, we increased the percentage of adolescents receiving contraceptive prescriptions within 14 days of indicating they were interested in starting a contraceptive. Improvement in the outcome measure was accomplished through improvements in 2 process measures: 1) increased documentation of interest in contraception and 2) improved access to referrals for contraceptive services and etonogestrel subdermal implant placement.

Keywords: adolescents; contraception; documentation; electronic medical records; pregnancy; quality improvement.