Reproductive health and sexual services eyed
ARHP project to address access and availability
Increasing the capacity of U.S. clinicians to provide high quality sexual and reproductive health (SRH) care for all Americans is an urgent public health priority, and proponents are working fast to implement new strategies to meet the need.
Most of the patients receiving SRH services in the United States are cared for by teams of providers, which include such personnel as front office staff, clinical support staff, and the administrative team, as well as clinicians. Most SRH clinical services are not provided by physicians. Most providers are nurses, advanced practice registered nurses, nurse-midwives, physician assistants, and pharmacists. At the present time, there is no universal access to all of these potential providers. This lack of universal access limits efforts to reduce rates of unintended pregnancy and sexually transmitted infections, as well as to provide quality sexual and reproductive healthcare.
With the expected addition of 30 million newly insured patients to the primary care system under the Affordable Care Act (ACA), the U.S. health system will need additional clinicians trained to provide a broad range of sexual and reproductive health services. To be effective, all members of the interprofessional primary care team will need to provide or support evidence- based and competency-based sexual and reproductive health care to women and men.
Current primary care systems and the clinicians who work within them are not adequately prepared to meet this demand with efficient, comprehensive, high quality sexual and reproductive health care. Recognizing the urgent need for collective action, the Association of Reproductive Health Professionals (ARHP) developed the Sexual and Reproductive Health Workforce Project in collaboration with dozens of other non-profit, foundation, and agency partners.
The project’s purpose is to increase the availability of and access to high quality sexual and reproductive health care in the United States. According to Joyce Cappiello, PhD, FNP-BC, co-chair of the SRH Workforce Project’s expert advisory committee, "The changes put into place through the ACA give our field an opportunity and a sense of urgency to more fully integrate SRH into primary care."
Summit leads charge
Current primary care systems and the clinicians who support work within them are not adequately prepared to meet this demand with efficient, comprehensive, high quality sexual and reproductive health care. Recognizing the urgent need for collective action, the Association of Reproductive Health Professionals (ARHP) developed the Sexual and Reproductive Health Workforce Project in collaboration with dozens of other non-profit, foundation, and agency partners. The Project’s purpose is to increase the availability of and access to high quality sexual and reproductive health care in the United States.
To gain perspective on the challenge, a Sexual and Reproductive Health Workforce Summit was held in January 2013. It included 40 experts from clinical practice, academia, medical societies, agencies, donors, and advocacy groups.
Summit participants were charged with developing recommendations to align and improve SRH health pre-licensure education, continuing professional development, and service delivery in the United States.
Recommendations include the following:
- Enhance SRH health professional education.
- Enhance SRH continuing professional development.
- Implement quality measures and standards for SRH care.
- Create incentives to expand and diversify the SRH workforce.
- Create incentives to optimize patient access to care.
- Develop a marketing/media campaign to reach out to advocacy groups to raise awareness of the importance of access to SRH care.
Three groups formed
Three working groups are now focused on putting the sworkshop’s ummit’s goals into action. The first working group is charged with defining SRH core competencies across key health professions, including advanced practice nurses, primary care physicians, physician assistants, pharmacists, and registered nurses. Group members will work with educational experts in key professions to identify curricular resources to enhance training in SRH core competencies across professions, conduct gap analyses, and disseminate findings to educational organizations.
The second working group is charged with developing an inter-professional National SRH Training Network. Group members will leverage existing training sites and networks to develop shared, inter-professional training, education, and simulation centers for SRH training. These sites may include Area Health Education Centers, community health centers, Title X and Planned Parenthood training centers, and academic centers.
Many federal groups, including the Interprofessional Education Collaborative, the Institute of Medicine, and the Health Resources and Services Administration, have identified interprofessional education and collaborative practice as a priority. In the initial workshop, the expert panel defined "team" to include all professionals working in a healthcare setting, including clinicians, medical assistants, community service providers, administrators, and office staff as well as other clinical, management, and support staff. Education and training initiatives will be developed for all team members. To address a wide range of needs, project officials look to develop shared training sites and a "traveling trainers" network for didactic education, simulation technology, and hands-on training.
The third working group is focusing on implementing SRH quality and performance measures and standards. Priorities include the development of a measure suitable for use as a Healthcare Effectiveness Data and Information Set (HEDIS) and identification of strategies to collect SRH data using electronic health records. Financial incentives will be implemented to reflect SRH quality and performance measures.
Project officials also are looking at creating incentives to expand and diversify SRH workforce and optimize patient care. This step would include such strategies as expanding loan repayment for clinicians providing SRH care in areas of need, including Title X clinics and community health centers, addressing credentialing and regulatory barriers that limit the SRH scope of practice, and identifying and evaluating creative models to enhance access to SRH services, such as co-locating SRH clinicians in primary care settings and creating integrated systems of referral, services, and electronic health records that facilitate care coordination and seamless or integrated referral for SRH services.
Officials also look to engage with insurers to determine what evidence or policies would move them to support providing SRH in primary care. Finally, Summit experts recommended that ARHP work with the field to compile existing resources into an open access, central repository for general use.
"All members of the healthcare team, including all of the professional organizations that represent them, can benefit from an easily accessible database of tools and resources in sexual and reproductive health," says Cappiello.
What is the next step? Project officials are looking to convene expert project teams representing the field for each initiative to advance work and map out strategies for continued progress. (See the guest column by Diana Taylor, RNP, PhD, FAAN, summit participant, on the importance of the project, p. 103.)
Efforts also are being made to engage with key constituencies and partners to identify synergies and develop specific strategies for action. Officials are looking at organizations and alliances already working in key areas of SRH, the ACA, primary care, and training and certification. An emphasis will be made on organizations with ties to state-level activity, in recognition that the ACA will be implemented largely at the state level. Melissa Nothnagle, MD, SRH Workforce Project co-chair, said, "It is essential that this effort be truly inclusive and involve the entire workforce to be effective. This is not about reinventing the wheel. It is about being truly collaborative, efficient, and goal-directed as a field."
Innovative demonstration projects will be identified to support their adaptation, evaluation, and expansion. Mechanisms will be developed to ensure alignment of efforts across SRH education, training, and service delivery.
How can programs get involved? Creative service delivery strategies, relevant activities comments, suggestions, and questions to should be submitted via e-mail to SRHWorkforce@arhp.org. ARHP will continue to act as a clearinghouse of teaching-learning resources through its Curricula Organizer for Reproductive Health Education (CORE), an online collection of peer-reviewed, evidence-based teaching materials. (To access CORE material, visit the ARHP web site, www.arhp.org, and click on the CORE icon.)
Wayne Shields, ARHP president and CEO, says, "If you have produced high quality SRH educational materials, we encourage you to go to http://core.arhp.org/submit and submit them for inclusion so that they can be made widely available to others."