University of Chicago, Department of Family Medicine, Chicago, IL, USA.
AllianceChicago, Chicago, IL, USA.
Contraception. 2024 Jan;129:110305. doi: 10.1016/j.contraception.2023.110305. Epub 2023 Oct 6.
Nearly one-third of low-income women of reproductive age in the U.S. receive care in federally qualified community health centers, 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 normalizing reproductive health screening for patients in federally qualified community health centers (FQHCs).
This multi-method program evaluation used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with retrospective and prospective data collection from three Illinois FQHCs who participated as Quality Hubs, and from a Community Advisory Board. We conducted descriptive analysis of patient surveys using the Person-Centered Contraceptive Counseling (PCCC) measure (n = 142); clinician and staff pre-and post-training surveys (n = 210); and Community Advisory Board surveys (n = 8) collecting quantitative and qualitative feedback. We ran logistic regression on claims data from 15- to 49-year-old patients identified as female at birth (n = 103,756).
Reach assessment showed patients receiving contraceptive or preconception care increased from 1063 per month in 2020 to 1236 per month in 2021 (16% increase), while general volume increased 2%. Effectiveness showed most patients (78%) described the quality of contraceptive counseling as "excellent" on the PCCC. Adoption assessment showed knowledge increases after clinical training on Modern Contraception (85% pre-training, 95% post-training) and Reproductive Justice (RJ) (58% pre-training, 70% post-training). Implementation assessment found that most Community Advisory Board members felt ICAN! was responsive to community needs.
The ICAN! demonstration year increased provider knowledge and volume of reproductive care at three Illinois FQHCs.
Contraceptive access initiatives that operationalize same day access to birth control methods while training FQHC providers on RJ and modern contraception, show promise on several measures. Early evidence from ICAN! indicates increased reproductive health service provision, as well as increases in provider knowledge of RJ and modern contraceptive care.
在美国，近三分之一的育龄低收入女性在联邦合格社区卫生中心接受护理，但并非始终提供全面的生殖保健服务。伊利诺伊州避孕准入现在（ICAN！）是一项旨在解决高质量避孕护理获取差距的计划，重点是为联邦合格社区卫生中心（FQHC）的患者规范生殖健康筛查。
本多方法计划评估采用了可达性、有效性、采用、实施、维持（RE-AIM）框架，从作为质量中心参与的伊利诺伊州三个 FQHC 以及社区咨询委员会收集回顾性和前瞻性数据。我们使用以人（患者）为中心的避孕咨询（PCCC）衡量标准对患者调查（n=142）进行描述性分析；对临床医生和工作人员进行培训前后的调查（n=210）；并对社区咨询委员会调查（n=8）进行调查，收集定量和定性反馈。我们对 15 至 49 岁被认定为女性的患者（n=103756）的索赔数据进行逻辑回归分析。
可达性评估显示，接受避孕或孕前保健的患者从 2020 年每月 1063 例增加到 2021 年每月 1236 例（增加 16%），而总人数增加了 2%。有效性表明，大多数患者（78%）在 PCCC 上表示避孕咨询质量“优秀”。采用评估显示，在接受现代避孕（85%培训前，95%培训后）和生殖正义（RJ）（58%培训前，70%培训后）的临床培训后，知识有所增加。实施评估发现，大多数社区咨询委员会成员认为 ICAN！对社区需求做出了回应。
ICAN！示范年增加了伊利诺伊州三个 FQHC 的提供者知识和生殖保健服务量。
在为 FQHC 提供者提供 RJ 和现代避孕知识培训的同时，使当天获得避孕方法的机会化的避孕获取计划在几个方面显示出了希望。来自 ICAN！的早期证据表明，生殖健康服务的提供有所增加，以及提供者对 RJ 和现代避孕护理的知识有所增加。
