New guidance uses best evidence to direct family planning services
Guidance aims for improved reproductive health outcomes for women, men
The Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services have just issued new guidance to improve the quality of family planning services. The Providing Quality Family Planning Services — Recommendations of CDC and the U.S. Office of Population Affairs (QFP) define what services should be offered in a family planning visit and gives providers the information they need to improve family planning services.
The recommendations were developed collaboratively by the two agencies and were based on a rigorous systematic review of the available evidence and extensive input from a broad range of clinical experts. (Read the guidance online at http://1.usa.gov/1jX4SOp.)
Why is the new guidance needed? The United States continues to face challenges to improving the reproductive health of the population, say public health officials. Nearly 50% of all pregnancies are unintended, with more than 700,000 adolescents ages 15-19 becoming pregnant each year and more than 300,000 giving birth. One of eight pregnancies in the United States results in preterm birth, and infant mortality rates remain high, compared with those of other developed countries.1
For the first time, CDC and OPA encourage using the family planning visit to provide essential preventive services such as breast and cervical cancer screening, in accordance with recommendations for women issued by the Institute of Medicine.2
The new guidance also addresses the needs of male clients, includes a special section on serving adolescents, and it provide detailed guidance on educating clients about the effectiveness of long-acting reversible contraception (LARC). Overall, the new recommendations integrate and fill gaps in other guidelines for the family planning setting, including those developed for contraception, achievement of pregnancy, preconception, and sexually transmitted infections (STIs), including HIV.
The recommendations cover the following:
• Describe what services should be offered in a family planning visit: contraceptive services, pregnancy testing and counseling, advice for achieving pregnancy, as well as information on basic infertility, preconception health, and STI services. They also describe how these services should be provided.
• Address the needs of female and male clients, describe how to provide services to special populations such as adolescents, provide detailed guidance on how to provide contraceptive services, and encourage providers to discuss contraceptive effectiveness with clients seeking to prevent pregnancy.
• Encourage using the family planning visit to provide other essential preventive health services, such as blood pressure screening and breast and cervical cancer screening.
Follow the steps
The QFP recommendations are designed to help reduce negative health outcomes and to increase the number of women and men who are able to achieve their desired number and spacing of healthy children, said Susan Moskosky, MS, WHNP-BC, acting director of the OPA, who participated in a webinar announcing the guidance’s release. (A link to the webinar transcript, as well as other QFP materials, is available at http://1.usa.gov/1s9dry7, under "May 8, 2014.")
Providing quality counseling is an essential component of client-centered care, and counseling is defined as a process that enables clients to make and follow through on decisions, said Moskosky. Education is an integral component of the counseling process that helps clients to make informed decisions. Use the five key principles of quality counseling to get your information across:
• establishing and maintaining rapport with the client;
• assessing the client’s needs;
• working with the client interactively to establish a plan;
• providing information that can be understood and retained by the client;
• confirming client understanding.
While these principles initially were developed specific to the provision of contraceptive counseling, they can be applied to a variety of family planning services, said Moskosky. Clinicians also should establish the following steps in providing contraceptive services:
• establishing and maintaining rapport with the client;
• obtaining clinical and social information from the client;
• working with the client interactively to select the most effective and appropriate contraceptive method for him or her;
• conducting a physical assessment related to the contraceptive use when warranted;
• providing the contraceptive method along with instructions about consistent and correct use;
• helping the client to develop a plan for using that selected method and for follow up and documenting client understanding. [Use the Family Planning and Related Preventive Health Services Checklists for Women and Men developed by the Family Planning National Training Centers. They are included with the online issue of Contraceptive Technology Update. Go to www.reliasmedia.com. On the right side of the page, see "Access Your Newsletters. Sign In." You’ll need your subscriber number from your newsletter envelope or your invoice. If you need help accessing the online document, contact customer service at (800) 688-2421 or firstname.lastname@example.org.]
Get out the word
The CDC and OPA are planning numerous activities designed to disseminate and support implementation of the new guidance in family planning and other primary care settings, says Lorrie Gavin, MPH, PhD, senior health scientist in the CDC’s Division of Reproductive Health.
Presentations about the guidance are being made at several national reproductive health conferences, Gavin reports. (The presentation at the recent meeting of the National Family Planning and Reproductive Health Association is available for viewing at http://bit.ly/1oYi9ch.)
Numerous papers about the new guidance are scheduled to be released in peer-reviewed journal articles throughout the year, says Gavin. Just released is an article in the August 2014 issue of Journal of Women’s Health, she notes.
CDC and OPA officials have convened numerous regional webinars with the Title X community, states Gavin. Electronic list-servs and eblasts have been used to announce the release of the guidance and targeted national organizations engaged in family planning, professional medical associations, maternal/child health providers, and others, she says.
Organizers also are working on several activities that they hope will support actual implementation by providers, reports Gavin. OPA-funded national training centers are developing training materials that will give providers the knowledge and skills needed to deliver services in accordance with QFP recommendations. The materials will include job aids, patient education materials, and suggestions for ways to modify the clinic environment to facilitate the delivery of recommended services. Materials will be available to all providers; visit www.fpntc.org.
Organizers are exploring the role that performance measurement and quality improvement can play in supporting implementation of QFP recommendations and in improving the quality of care, says Gavin. "For example, we plan to submit two performance measures of contraceptive services to the National Quality Forum for their endorsement, and they will be integrated into the Title X program after endorsement," says Gavin. "We also are discussing adoption of these measures with representatives from other health systems, such as Medicaid, Maternal and Child Health Bureau program staff, and community health centers."
Organizers are exploring the role that clinical decision support tools can play in facilitating the delivery of family planning services, notes Gavin. For example, organizers are exploring tools that: automatically prompt the provider to ask about pregnancy intention at least once/year and to document in the medical record the client’s intention and contraceptive method selected at the end of the visit; identify the preconception, STI, and related preventive health screening services that should be offered to a client, given the client’s characteristics; and identify the contraceptive methods that are safe (per the U.S. Medical Eligibility Criteria for Contraceptive Use) for a client, given her characteristics, states Gavin.
- Gavin L, Moskosky S, Carter M, et al. Centers for Disease Control and Prevention (CDC). Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014; 63(RR-04):1-54.
- Institute of Medicine. Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: The National Academies Press; 2011.