Systems Change Enhances Access to Family Planning Training and Care Delivery

BACKGROUND AND OBJECTIVES: Long-acting reversible contraceptives (LARCs) are very effective methods of pregnancy prevention. To ensure autonomy over childbearing, women need access to contraception and abortion services. Family physicians can improve access by increasing numbers and locations of trained providers. In 2014, the University of Maryland (UMD) Reproductive Health EDucation In family medicine (RHEDI) program sought to enhance LARC and abortion training by increasing: (1) resident participation in LARC services, (2) resident participation/interest in abortion care, (3) patient access to LARCs and medication abortions (MABs).

DESIGN: We used a pre-post framework comparing years 2013 and 2014 with respect to number of resident-provided LARC services, number of residents participating in abortion, and total number of LARCs and MABs provided practice-wide.

SETTING: The setting is an urban residency practice.

INTERVENTION: (1) increased dedicated appointments for LARC and MABs, (2) dedicated appointment scheduler, (3) comprehensive family planning didactics and clinical workshops, (4) faculty-supported Residents for Choice group.

RESULTS: 2014: Residents provided substantially more LARC services compared to 2013. Placement increased from 50 to 90, and removals tripled (25 to 73). 2014 site-wide LARC placement also increased (160 versus 98), removals increased (44 in 2013, 106 in 2014). Twelve residents per year are eligible to participate in abortion care. In 2013, two participated: in 2014, 10 participated. MABs provided in 2014 (18) did not change from 2013 (17).

CONCLUSIONS: The UMD RHEDI program demonstrated that attention to care-provision systems and education enhances resident training and increases patient access to family planning services. Programs with similar goals may find our methods helpful.