Reproductive Care in Community Health Centers: A Multi-Method Evaluation of Illinois Contraceptive Access Now demonstration

Abstract

Listen

Translate article

<h3>Context:</h3> Community health centers (CHCs) serve patients with disproportionate rates of poverty and chronic conditions in the United States (US). Nearly one-third of low-income US women of childbearing age receive care in CHCs, but comprehensive reproductive care is not consistently provided. Illinois Contraceptive Access Now (ICAN!) is an initiative addressing the access gap to high-quality contraceptive care with a focus on federally qualified health centers (FQHCs). <h3>Objective:</h3> Conduct a multi-method evaluation of ICAN!’s demonstration project with three Illinois FQHCs (13 clinic sites). <h3>Study Design and Analysis:</h3> We analyzed data from the FQHCs who participated as ICAN! Quality Hubs (QH), and from the ICAN! Community Advisory Board (CAB). <h3>Setting or Dataset:</h3> QH data included patient surveys using the 4-item National Quality Forum-endorsed Person-Centered Contraceptive Counseling (PCCC) measure (n=87); clinician and staff pre and post-training surveys (n=210); and clinic claims data. CAB survey data included quantitative and qualitative feedback from CAB members (n=8). <h3>Population Studied:</h3> Reproductive age (15-49 years) patients identified as female sex at birth. <h3>Intervention:</h3> ICAN! is designed to de-silo and de-stigmatize contraceptive services by supporting all providers who care for reproductive age patients to routinely ask about contraceptive needs and desires. <h3>Outcome Measures:</h3> 1) Percent of patients describing their contraceptive counseling as “excellent” on all PCCC items; 2) change in clinician and staff knowledge of Reproductive Justice principles and updated contraceptive evidence; 3) change in the number and % of eligible patients at participating FQHCs who received at least one contraceptive service encounter. <h3>Results:</h3> Most patients (78%) described the quality of their contraceptive counseling as uniformly “excellent” on the PCCC. Clinical training assessments showed increases in knowledge related to Reproductive Justice (58% pre-training, 70% post-training) and Modern Contraception (85% pre-training, 95% post-training). The number of patients receiving contraceptive care increased over the study period from 1,086/month in Jan 2020 to 1,267/month in Dec 2021, an increase of over 16.6%. Finally, CAB members described ICAN! as responsive to community needs with suggestions for future community engagement. <h3>Conclusions:</h3> The ICAN! demonstration increased provider knowledge and volume of contraceptive care at three Illinois FQHCs.