Rachel Curry, DNP '19; Anne Derouin, associate professor; Julie Thompson, research and statistical associate; and Eleanor Stevenson, associate professor; recently published an article entitled "A QI project to assess the feasibility of using One Key Question® in retail health clinics" in Women's Healthcare. Co-authors include Katherine Kenny and Debra Goulding.
This article was featured in the DNP Projects: Spotlight on Practice section of the journal.
One goal of Healthy People 2020 is improving pregnancy planning, increasing spacing between pregnancies, and decreasing unintended pregnancy.1 As the situation stands now, almost half of all pregnancies in the United States are unintended.2 Only 14% of ambulatory care encounters with women of reproductive age include provision of contraception and preconception services,3 which, if offered on a broader basis, would go a long way toward reducing the rate of unintended pregnancies and improving women’s health and pregnancy outcomes.
In 2006, the CDC recommended reproductive life planning (RLP) as an approach that could be introduced at healthcare visits.4 RLP is a process in which healthcare providers (HCPs) and female patients or couples engage in discussions that serve to identify their family planning goals and then make healthcare plans collaboratively in order to safely and realistically meet those goals.5 Key components of RLP include consideration of the desire for children, number of children desired, spacing of children, and timing of children. Preconception and contraceptive counseling are provided as appropriate, and referrals are made as needed.5
One Key Question® (OKQ) is an evidence-based intervention used to help initiate the discussion between HCPs and female patients concerning reproductive desires and goals.6 Developed by the Oregon Foundation for Reproductive Health, OKQ uses a simple prompt— Would you like to become pregnant in the next year?—in order to move the health visit conversation toward these goals. The ensuing conversation then focuses on patients’ desire for pregnancy rather than their specific plans. The OKQ algorithm includes three response categories: yes, no, and I’m not sure or I’m okay either way (Algorithm). This non-confrontational approach focuses on each woman’s desire for pregnancy, with the aim of opening the RLP dialogue with the HCP, which will then, under ideal circumstances, connect the woman to the most appropriate healthcare services.7 The OKQ screening tool has been piloted in multiple settings in Oregon and one setting in Missouri. Three clinical trials are now under way to study the impact of screening and the service delivery patterns for preventive reproductive healthcare (i.e., contraception and preconception care).8
Finding non-traditional avenues for HCPs and women to engage in RLP discussions is important, particularly in terms of reaching women who do not regularly see a primary care or ob/gyn provider for reproductive healthcare. Retail health clinics (RHCs) commonly used for episodic acute care may provide such an avenue. RHCs offer convenience, including accessible locations, walk-in service, and ease of obtaining appointments for morning, evening, and weekend hours. HCPs at RHCs conduct comprehensive health assessments, make diagnoses, and develop care plans that include education and referrals as needed. These HCPs have an ideal opportunity to screen reproductive-aged women for pregnancy intention and to increase awareness about contraception options and healthful preconception behaviors. Folic acid supplements can be recommended or prescribed on site. Appropriate referrals can be made to primary care and ob/gyn providers in the community to meet reproductive healthcare needs.
Four RHCs identified in Maricopa County, Arizona, were not currently screening for pregnancy intention. The authors determined that the absence of such screening in these clinics offered them an opportunity to pilot the use of the OKQ screening tool/algorithm in the clinics.