Same-day Access Research Articles

Same Day Access to Folded Synthetic Proteins.

Understanding protein function is a cornerstone of modern biology. Research centers worldwide dedicate significant efforts to prepare individual proteins for study, the isolation and purification of which can take days to months. We developed a workflow that enables same-day access to functional synthetic proteins. Chemical synthesis provides access to crude protein chains in hours, but the removal of the synthetic side products is typically a days-long process. We find that chemical modifications on side products lead to significant and unpredictable changes in the folding behavior. Consistent with these findings, we discovered that approaches based on biophysical properties characteristic of the folded protein target can discriminate against chemically similar species. Confirming our protocol with nine protein targets, we show that appropriate desalting followed by different folding strategies enables isolation of functional single-domain proteins in hours instead of days. Each target was isolated in under 10 h, including some proteins with post-translational modifications, non-natural amino acids, and disulfide bonds. Rapid biological discovery requires on-demand access to proteins, and the folding pipeline described here is uniquely suited to enabling these efforts. The folding process presented here was not assessed on complex proteins, and therefore, it may require further optimization in those cases.

Advancing Primary Care Access: Exploring the Impact of the Virtual Waiting Room on the Quadruple Aim.

Community health centers grapple with high no-show rates, posing challenges to patient access and primary care provider (PCP) utilization. To address these challenges, we implemented a virtual waiting room (VWR) program in April 2023 to enhance patient access and boost PCP utilization. Academic community health center in a small urban city in Massachusetts. Community health patients (n = 8706) and PCP (n = 14). The VWR program, initiated in April 2023, involved nurse triage of same-day visit requests for telehealth appropriateness, then placing patients in a standby pool to fill in as a telehealth visit for no-shows or last-minute cancellations in PCP schedules. Post-implementation, clinic utilization rates between July and September improved from 75.2% in 2022 to 81.2% in 2023 (p < 0.01). PCP feedback was universally positive. Patients experienced a mean wait time of 1.9h, offering a timely and convenient alternative to urgent care or the ER. The VWR is aligned with the quadruple aim of improving patient experience, population health, cost-effectiveness, and PCP satisfaction through improving same-day access and improving PCP schedule utilization. This innovative and reproducible approach in outpatient offices utilizing telehealth holds the potential for enhancing timely access across various medical disciplines.

Chemotherapy Care Companion: Enhancing cancer care through digital remote monitoring.

1636 Background: Oncology patients often encounter preventable acute issues prompting the need for proactive monitoring and management. To manage disease and therapy complications, Ochsner Health developed Chemotherapy Care Companion (CCC) for remote monitoring of treatment patients. This abstract highlights the feasibility of digital remote monitoring (DRM) in managing oncologic patient care, while increasing patient satisfaction and reducing patient events and healthcare costs. Methods: Starting in January 2021, patients initiating an oral or intravenous cancer treatment with an active Ochsner portal account and smartphone became eligible. Providers can manually enroll patients via an order set and receive enrollment reminders within the Epic electronic medical record (EMR). Patients receive a digital WiFi-enabled monitoring scale, blood pressure cuff, and ear thermometer, at no cost. Patients are reminded via phone alerts to take vitals at 9am and 3pm, along with a daily questionnaire. The data is transmitted wirelessly to the EMR, where abnormal vital signs or questionnaire responses trigger escalations sent to an Epic in-basket pool. During clinic hours, advanced practice providers (APPs) review and intervene, utilizing embedded urgent care slots for same-day access. In August 2022, a patient satisfaction survey comprising of nine questions was distributed to all enrolled patients. Results: A retrospective analysis was conducted from September 2022 to August 2023 including 722 participants, 7,360 escalations and 668 interventions. Patient compliance reached 62%, defined as submitting at least 50% of daily vitals. The most common interventions were related to hypertension, hypotension, weight changes, and questionnaire responses. Regarding questionnaire responses, diarrhea, pain, fever, and dizziness were the mostly frequently triaged. Data analytics revealed that CCC led to a 5.9% decrease in emergency room visits, a 41.7% decrease in the rate of inpatient hospital admissions, and a 32.3% improvement in the inpatient length of stay compared to non-enrolled patients. Extrapolating this data across 5,500 oncology patients within our hospital system, CCC could prevent 172 ER visits, 914 inpatient hospital admissions and 2,006 hospital days. The survey (131 responses) revealed high satisfaction with CCC: over 80% felt a sense of security, 90% were overall satisfied, and more than 90% would recommend CCC. Conclusions: Findings highlight the value of integrating DRM in cancer care, showcasing its ability to reduce healthcare costs and optimize resource utilization while enhancing patient care and satisfaction. Moreover, the study underscores the high patient satisfaction and engagement with DRM, bolstering its feasibility and acceptance in oncology care. Further investigation is warranted to explore the financial benefits for hospitals, insurance companies, and pharmaceutical companies.

Impact of Primary Care-Mental Health Care Integration on Mental Health Care Engagement Across Racial and Ethnic Groups.

Receiving mental health services as part of primary care in the Veterans Health Administration (VHA) might increase engagement in specialty mental health care. The authors reexamined the association between primary care-mental health integration (PCMHI) and continued engagement in specialty mental health care for VHA patients and assessed differences by race and ethnicity. The study included 437,051 primary care patients with a first in-person specialty mental health encounter in 2015-2016 (no specialty mental health encounters in prior 12 months), including 46,417 patients with new PCMHI encounters in the year before the first specialty mental health encounter. Multivariable logistic regression assessed odds of follow-up specialty mental health care within 3 months of the first specialty mental health encounter. The dependent variable was care engagement (attending a second specialty mental health appointment); independent variables were whether patients were seen by PCMHI on the same day as the primary care appointment ("same-day access"), the time between PCMHI and first specialty mental health appointments, and race and ethnicity. PCMHI was associated with increased engagement in specialty mental health care for all patients, with a greater likelihood of engagement among non-Hispanic White patients. Same-day access to PCMHI was positively associated with care engagement, with no significant differences by race or ethnicity. PCMHI care within 3 months before a first specialty mental health encounter was associated with greater care engagement. PCMHI, especially same-day access to PCMHI care, may boost engagement in mental health care, although the study design precluded conclusions regarding causal relationships.

Naloxone Accessibility by Standing Order in North Carolina Community Pharmacies

BackgroundAccording to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription. ObjectiveThe objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC. MethodsA cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023. Trained “secret shoppers” enacted a standardized script and recorded whether naloxone was available and its cost. We examined the relationship between out-of-pocket naloxone cost, pharmacy type, and rurality. ResultsNaloxone could be purchased in 53% of the pharmacies contacted; 26% incorrectly noting that naloxone could be filled only with a provider prescription and 21% did not sell naloxone. Naloxone availability by standing order was statistically different by pharmacy type (chain/independent) (χ2 = 20.58, df = 4, P value < 0.001), with a higher frequency of willingness to dispense according to the standing order by chain pharmacies in comparison to independent pharmacies. The average quoted cost for naloxone nasal spray at chain pharmacies was $84.69; the cost was significantly more ($113.54; P < 0.001) at independent pharmacies. Naloxone cost did not significantly differ by pharmacy rurality (F2,136 = 2.38, P = 0.10). ConclusionApproximately half of NC community pharmacies audited dispense naloxone according to the statewide standing order, limiting same-day access to this life-saving medication. Costs were higher at independent pharmacies, which could be due to store-level policies. Future studies should further investigate these cost differences, especially as intranasal naloxone transitions from a prescription only to over-the-counter product.

Same-Day Access in Oncology: A Patient-Centric Paradigm for Health Care Delivery.

Same-Day Access in Oncology: A Patient-Centric Paradigm for Health Care Delivery.

Mobile treatment for opioid use disorder: Implementation of community-based, same-day medication access interventions

BackgroundMedications for Opioid Use Disorder (MOUD) are lifesaving, but <20 % of individuals in the US who could benefit receive them. As part of the NIH-supported HEALing Communities Study (HCS), coalitions in several communities in Massachusetts and Ohio implemented mobile MOUD programs to overcome barriers to MOUD receipt. We defined mobile MOUD programs as units that provide same-day access to MOUD at remote sites. We aimed to (1) document the design and organizational structure of mobile programs providing same-day or next-day MOUD, and (2) explore the barriers and facilitators to implementation as well as the successes and challenges of ongoing operation. MethodsProgram staff from five programs in two states (n = 11) participated in semi-structured interviews. Two authors conducted thematic analysis of the transcripts based on the domains of the social-ecological model and the semi-structured interview guide. ResultsMobile MOUD units sought to improve immediate access to MOUD (“Our answer is pretty much always, ‘Yes, we'll get you started right here, right now,’”), advance equity (“making sure that we have staff who speak other languages, who are on the unit and have some resources that are in different languages,”), and decrease opioid overdose deaths.Salient program characteristics included diverse staff, including staff with lived experience of substance use (“She just had that personal knowledge of where we should be going”). Mobile units offered harm reduction services, broad medical services (in particular, wound care), and connection to transportation programs and incorporated consistency in service provision and telemedicine access.Implementation facilitators included trusting relationships with partner organizations (particularly pharmacies and correctional facilities), nuanced understanding of local politics, advertising, protocol flexibility, and on-unit prescriber hours.Barriers included unclear licensing requirements, staffing shortages and competing priorities for staff, funding challenges due to inconsistency in grant funding and low reimbursement (“It's not really possible that billing in and of itself is going to be able to sustain it”), and community stigma toward addiction services generally. ConclusionsDespite organizational, community, and policy barriers, participants described mobile MOUD units as an innovative way to expand access to life-saving medications, promote equity in MOUD treatment, and overcome stigma.

Effect of a Same-Day-Appointment Initiative on Access-Related Benchmarks in Radiation Oncology

The timely delivery of health care is an important quality indicator that has been shown to correlate with outcomes for cancer patients. We present our single-institution experience with the implementation of a same-day-access scheduling initiative in outpatient radiation oncology. From March 2021 to March 2023, a total of 4301 consecutive new patients referred for radiation oncology consultation were offered same-day appointments as part of a prospective pilot initiative conducted at a tertiary-based academic medical center. Descriptive statistics were used to study the effect of this initiative on access-related benchmarks compared with historical control patients referred during a preceding 24-month period. Among the 3414 patients scheduled, 477 (14%) opted for same-day appointments. Black, Latino, and Asian patients were significantly more likely to use same-day access versus Caucasian patients (P < .001). The same-day-access initiative increased the proportion of patients seen within 5 days from referral from 22% to 61% (P < .001). The median time from referral to consult was 12 days (range, 0-149 days) before the implementation of the same-day-access initiative compared with 3 days (range, 0-101 days) after (P < .001). The no-show rate was reduced from 15% to 7% with the initiative (P < .001). All patients who requested a same-day appointment were successfully accommodated. The implementation of this same-day-access initiative enhanced operational efficiency and reduced barriers to care in the outpatient setting.

The association between patients' timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study.

Challenges in timely access to one's usual primary care physician and the ongoing use of walk-in clinics have been major health policy issues in Ontario for over a decade. We sought to determine the association between patient-reported timely access to their usual primary care physician or clinic and their use of walk-in clinics. We conducted a cross-sectional study of Ontario residents who had a primary care physician by linking population-based administrative data to Ontario's Health Care Experience Survey, collected between 2013 and 2020. We described sociodemographic characteristics and health care use for users of walk-in clinics and nonusers. We measured the adjusted association between self-reported same-day or next-day access and after-hours access to usual primary care physicians or clinics and the use of walk-in clinics in the previous 12 months. Of the 60 935 total responses from people who had a primary care physician, 16 166 (weighted 28.6%, unweighted 26.5%) reported visiting a walk-in clinic in the previous 12 months. Compared with nonusers, those who used walk-in clinics were predominantly younger, lived in large and medium-sized urban areas and reported a tight, very tight or poor financial situation. Respondents who reported poor same-day or next-day access to their primary care physician or clinic were more likely to report having attended a walk-in clinic in the previous 12 months than those with better access (adjusted odds ratio [OR] 1.23, 95% confidence interval [Cl] 1.13-1.34). Those who reported being unaware that their primary care physician offered after-hours care had a higher likelihood of going to a walk-in clinic (adjusted OR 1.14, 95% Cl 1.07-1.21). In this population-based health survey, patient-reported use of walk-in clinics was associated with a reported lack of access to same-day or next-day care and unawareness of after-hours care by respondents' usual primary care physicians. These findings could inform policies to improve access to primary care, while preserving care continuity.

Parent's preferences for unscheduled paediatric healthcare: A discrete choice experiment.

Unscheduled healthcare is a key component of healthcare delivery and makes up a significant proportion of healthcare access, with children being particularly high users of unscheduled healthcare. Understanding the relative importance of factors that influence this behaviour and decision-making is fundamental to ensuring the system is best designed to meet the needs of users and foster appropriate cost-effective usage of health system resources. The aim of the study was to identify the parent's preferences for unscheduled healthcare for a common mild childhood illness. A discrete choice experiment (DCE) was developed to identify the preferences of parents accessing unscheduled healthcare for their children. Data were collected from parents in Ireland (N = 458) to elicit preferences across five attributes: timeliness, appointment type, healthcare professional attended, telephone guidance before attending and cost. Using a random parameters logit model, all attributes were statistically significant, cost (β = -5.064, 95% confidence interval, CI [-5.60, -4.53]), same-day (β = 1.386, 95% CI [1.19, 1.58]) or next-day access (β = 0.857, 95% CI [0.73, 0.98]), coupled with care by their own general practitioner (β = 0.748, 95% CI [0.61, 0.89]), identified as the strongest preferences of parents accessing unscheduled healthcare for their children. The results have implications for policy development and implementation initiatives that seek to improve unscheduled health services as understanding how parents use these services can maximise their effectiveness. The development of the DCE included a qualitative research component to ensure that the content accurately reflected parents experiences when seeking healthcare. Before data collection, a pilot test was carried out with the target population to gather their views on the survey.

Multidisciplinary teams, efficient communication, procedure services, and telehealth improve cirrhosis care: A qualitative study.

Cirrhosis care and outcomes are improved with access to subspecialty gastroenterology and hepatology care. In qualitative interviews, we investigated clinicians' perceptions of factors that optimize or impede cirrhosis care. We conducted 24 telephone interviews with subspecialty clinicians at 7 Veterans Affairs medical centers with high- and low-complexity services. Purposive sampling stratified Veterans Affairs medical centers on timely post-hospitalization follow-up, a quality measure. We asked open-ended questions about facilitators and barriers of care coordination, access to appointments, procedures, transplantation, management of complications, keeping up to date with medical knowledge, and telehealth use. Key themes that facilitated care were structural: multidisciplinary teams, clinical dashboards, mechanisms for appointment tracking and reminders, and local or virtual access to transplant and liver cancer specialists through the "specialty care access network extension for community health care outcomes" program. Coordination and efficient communication between transplant and non-transplant specialists and between transplant and primary care facilitated timely care. Same-day access to laboratory, procedural, and clinical services is an indicator of high-quality care. Barriers included lack of on-site procedural services, clinician turnover, patient social needs related to transportation, costs, and patient forgetfulness due to HE. Telehealth enabled lower complexity sites to obtain recommendations for complex patient cases. Barriers to telehealth included lack of credit (eg, VA billing equivalent), inadequate staff, lack of audiovisual technology support, and patient and staff discomfort with technology. Telehealth was optimal for return visits, cases where physical examination was nonessential, and where distance and transportation precluded in-person care. Rapid telehealth uptake during the COVID-19 pandemic was a positive disruptor and facilitated use. We identify multi-level factors related to structure, staffing, technology, and care organization to optimize cirrhosis care delivery.

Same day access: a viable alternative for outpatient clinical care

To present our experience with a novel, same-day access (SDA) scheduling model for outpatient clinical care in oral and maxillofacial surgery (OMS). The primary outcome variable was OMS patient scheduling in a hospital-based outpatient clinic. Patients were given a specific appointment time to be seen the same day they contacted the clinic. This SDA clinic was compared to previous patient scheduling models for patient satisfaction, appointment wait times, annual clinic volume, no-show rates, and access to care. Patient satisfaction increased to 80% with SDA scheduling compared with 20% to 40% with prior models. The average wait time for patients improved to 19 minutes compared with 330 minutes with the walk-in model. Forty patients were scheduled on the same day, and 96% of all patients who called the clinic were seen within 14 days with the SDA approach. Same-day access was the only model that met its volume and budgetary goals. The incorporation of SDA scheduling improves patient satisfaction and is a viable alternative to more traditional scheduling protocols for clinics suffering from volume, revenue, and access to care issues.

Effects of Virtual Care and Same-Day Access to Integrated Care on Specialty Mental Health Engagement in the Veterans Health Administration.

In the Veterans Health Administration (VA), Primary Care-Mental Health Integration (PC-MHI) clinics offer mental health services embedded in primary care, a strategy shown to reduce overall specialty mental health clinic burden while facilitating prompt referrals when indicated. Among newly initiated patients, same-day access to PC-MHI from primary care increases subsequent specialty mental health engagement. However, the impact of virtual care on the association between same-day access to PC-MHI and subsequent mental health engagement remains unclear. To examine the effects of same-day access to PC-MHI and virtual care use on specialty mental health engagement. We used administrative data from 3066 veterans who initiated mental health care at a large, California VA PC-MHI clinic during 3/1/2018 to 2/28/2022 and had no previous mental health visits for at least 2 years prior to the index appointment. We conducted Poisson regression analyses to examine the effects of same-day access to PC-MHI, virtual access to PC-MHI and their combined effect on subsequent specialty mental health engagement. Same-day access to PC-MHI from primary care was positively associated with specialty mental health engagement (IRR = 1.19; 95% CI 1.14-1.24). Virtual access to PC-MHI was negatively associated with specialty mental health engagement (IRR = 0.83; 95% CI 0.79-0.87). The positive effect of same-day access on specialty mental health engagement was smaller among patients who initiated PC-MHI in a virtual visit (IRR = 1.07) compared to in-person visits (IRR = 1.29; 95% CI 1.22-1.36). Although same-day access to PC-MHI increased overall specialty mental health engagement, the magnitude of this effect varied between in-person and virtual modalities. More research is needed to understand mechanisms of the association between virtual care use, same-day access to PC-MHI, and specialty mental health engagement.

Same-day long-acting reversible contraceptive utilization after a statewide contraceptive access initiative

Same-day placement of long-acting reversible contraceptives, occurring when the device is requested and placed within a single visit, reduces barriers to the patient and reduces unintended pregnancies. Despite the safety and efficacy of same-day placement, access to same-day services remains low. This study aimed to evaluate the effects of the Delaware Contraceptive Access Now initiative, a statewide initiative in Delaware focused on increasing same-day access to effective contraception on same-day receipt of long-acting reversible contraceptives. We used Medicaid claims and encounter data to identify instances of same-day and multivisit receipts of long-acting reversible contraceptives among Medicaid-enrolled individuals in Delaware and Maryland aged 15-44 years who were covered in a full-benefits or family planning Medicaid aid category during the month of the placement and the 2 previous months. We used a difference-in-differences design that compared changes in the outcome from before to after implementation of the initiative among placements at agencies that participated in the initiative (n=6676) vs 2 alternative comparison groups: placements at Delaware agencies that did not participate (n=688) and placements in Maryland (n=35,847). We found that the intervention was associated with a 13.3 percentage point increase (95% confidence interval, 1.9%-24.7%) in receipt of same-day long-acting reversible contraceptives using a nonparticipating Delaware comparison group, a 21.1 percentage point increase (95% confidence interval, 13.7%-28.6%) using a Maryland comparison group, and a 21.0 percentage point increase (95% confidence interval, 14.1%-27.9%) using a pooled comparison group. The effects were larger for implants than intrauterine devices. The Delaware Contraceptive Access Now initiative substantially increased the number of patients receiving long-acting reversible contraceptives through a single-visit encounter. Our findings suggested that coordinated interventions involving provider and staff training and capital investments that seed device stocking can increase the number of patients receiving same-day long-acting reversible contraceptives.

The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: A retrospective cohort study

BackgroundOpen-access opioid treatment programs (OTP) offer same-day access to methadone without an appointment and aim to minimize treatment barriers that often reduce admission and/or retention. We explored whether patients with benzodiazepine exposure at treatment entry would have similar 12-month retention compared to those without benzodiazepine exposure. MethodsWe conducted a retrospective cohort study of 2968 patients consecutively initiated on methadone between January 2015 and February 2017 at an open-access OTP. The sample was stratified into benzodiazepine-exposed and nonexposed groups based on intake urine toxicology. Group comparison of 12-month retention was conducted. Kaplan Meier analysis compared time to methadone treatment discontinuation between groups with a log-rank test. Multivariable Cox regression was performed to compare retention by baseline benzodiazepine exposure with adjustment for confounders. ResultsOverall, 31% of patients with benzodiazepine exposure (n = 171) and 31% without exposure (n = 2423) were retained at 12 months (p = 0.95). Median treatment duration was 182 days (95% CI, 152–239) and 175 days (95% CI, 156–196) for patients with and without benzodiazepine exposure, respectively. Kaplan-Meier analysis showed no significant difference in treatment duration between groups (log-rank test p = 0.73). Cox regression found no difference in treatment retention between groups (adjusted Hazard Ratio= 1.03, 95% CI, 0.91–1.16). ConclusionsIn this cohort of patients receiving methadone at an open-access OTP, benzodiazepine exposure at intake was not observed to impact 12-month treatment retention or duration. These findings support U.S. Food and Drug Administration (FDA) recommendations to not withhold medications for opioid use disorder from patients taking benzodiazepines.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

Association Between Virtual Care Use and Same-Day Primary Care Access in VA Primary Care-Mental Health Integration.

Introduction:Same-day referrals from primary care to mental health increase subsequent mental health treatment engagement. VA Primary Care-Mental Health Integration (PC-MHI) clinics offer integrated mental health services embedded in primary care clinics, providing a key entry point to mental health care. Although telehealth use expanded rapidly after the onset of COVID-19, the impact of telehealth on same-day primary care access among new PC-MHI mental health patients is unknown. To address this knowledge gap, we examined associations between telehealth use and same-day primary care access in VA PC-MHI.Methods:We examined electronic health record data to identify same-day primary care appointments among PC-MHI patients who initiated care during 3/1/2018 to 10/29/2021. We used logistic regression analyses to evaluate the effect of telehealth on same-day primary care access. Time, demographic characteristics, mental health diagnoses (PTSD and depression), and substance use disorder diagnosis were evaluated as covariates.Results:New PC-MHI patients who were seen via telehealth were less likely to receive same-day primary care access than patients seen in person (OR: 0.54; 95% CI: 0.41-0.71; P < .001).Conclusions:Despite the potential advantages of using telehealth to increase access, VA patients with an initial PC-MHI visit via telehealth were less likely than patients seen in person to be referred from primary care. Telehealth may adversely affect primary care referrals to mental health services, an outcome that could ultimately reduce specialty mental health care continuity. There is an urgent need to identify strategies to facilitate PC-MHI care coordination in the telehealth context.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

Outcomes of a two-visit protocol for long acting reversible contraception for adolescents and young adults

To examine outcomes of a 2-visit protocol for placement of intrauterine or subdermal contraception. We identified all women ages 15 to 27 who received an order for an intrauterine or subdermal contraceptive between January 2014-December 2016. We examined time from order to contraceptive placement and reasons for incomplete orders. We identified 1,192 unique patients who received 1,323 orders for intrauterine or subdermal contraceptives; 68% were completed at a second visit. The median time from order to placement was 22 days (interquartile range=15-35). Of incomplete orders, 41% were related to logistics of a subsequent visit. Twenty-eight percent of patients had a subsequent pregnancy within the study period. Efforts to provide same-day access for all contraceptive methods are needed.

Impact of a Health Communication Campaign on Uptake of Contraceptive Services during the 2016-2017 Zika Virus Outbreak in Puerto Rico

ABSTRACT The Zika Contraception Access Network (Z-CAN) was established during the 2016–2017 Zika virus outbreak in Puerto Rico as a short-term emergency response program providing client-centered contraceptive counseling and same-day access to the full range of reversible contraceptive methods at no cost to women wishing to delay pregnancy. An evidence-based communication campaign, Ante La Duda, Pregunta (ALDP), was launched to encourage utilization of Z-CAN services. We assessed the effectiveness of campaign tactics in increasing awareness of Z-CAN among women in Puerto Rico. Data on campaign exposure and awareness were obtained through a self-administered online survey approximately two weeks after an initial Z-CAN visit, while the number of searches for participating clinics were obtained from monitoring the campaign website. Findings demonstrated that the most common ways survey respondents learned about Z-CAN were through friends or family (38.3%), social media (23.9%), a clinical encounter (12.7%), and website (11.7%). Nearly two-thirds (61.1%) of respondents had heard of the ALDP campaign. Over the campaign’s duration, there were 27,273 searches for Z-CAN clinics. Findings suggest that evidence-based communication campaigns may increase awareness of needed public health services during emergencies. Word of mouth, social media, and digital engagement may be appropriate communication tactics for emergency response mobilization.