New Section research assesses systematic barriers to IUD care

iudAt the Section of Family Planning & Contraceptive Research, we are committed to conducting quality research about the effectiveness of IUDs as birth control, especially for young women.

IUDs require little user maintenance, last between 7 and 12 years, and are highly effective at preventing pregnancy. As our earlier research has shown, in order to reduce undesired pregnancy amongst young women, it is critical to remove unnecessary barriers to choosing the IUD. One way to improve the quality of IUD services and the number of women receiving this contraceptive method is to assess the underlying problems that prevent women from receiving an IUD at their scheduled appointment.

Section Chief Dr. Melissa Gilliam’s research on these systematic barriers to IUD care was published in the July 2014 online edition of Contraception.

This article describes the novel use of a systematic approach to evaluating clinical care, called Failure Modes Effects and Criticality Analysis (FMECA). This step-by-step approach was originally developed by engineers to evaluate high-risk industries such as nuclear power and commercial aviation in order to identify practices that contribute to poor quality, unsafe, or unreliable inefficiencies. When adapted to healthcare, team members use FMECA to evaluate the systems and processes of a specific type of clinic care (eg IUD care). “Failures” are identified from qualitative and quantitative data, determining the frequency and impact in order to prioritize redesign and improvements.

For example, a failure in IUD delivery would be a patient calling and cancelling an appointment, but the cancellation is not entered into the scheduling system.

Dr. Gilliam’s study used the FMECA process to evaluate IUD services at three Title X clinics and identified three main failures during the scheduling and intake processes: 1) The patient does not show up for appointment or cancels; 2) The patient recently had unprotected intercourse; and 3) Limited time for counseling, informing, and placing IUDs. This FMECA drew upon interviews with IUD clients, the clinical care team, and reviewed administrative data at all three clinics.

After reviewing the failures, the researchers and clinical care team created solutions to the identified failures: implementing a revised scheduling call script and developing an app to be used in the waiting room. To address cancellations and no-shows, the new call center script reminded patients to keep their appointment or call to cancel beforehand. The script also addressed the need to abstain from unprotected intercourse prior to the appointment. The third failure, limited time, was also addressed by this revision, which identified potentially eligible IUD patients beforehand and saved time at the actual appointment. The barrier of limited time was also addressed with the waiting room “app”, which maximized the wait time by counseling women about contraceptive options.

After the completion of this study, the research team developed an online toolkit describing processes, procedures, and tools for an FMECA and shared with Title X clinics nationally.

To read our published research on the impact of the revised call script and the waiting room app, click here and here.

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