Title: Integrating Comprehensive Family Planning services into primary care in a Federally Qualified Health Center: New Approaches Involving the Entire Healthcare Team
Authors: Lucy Loomis, M.D., M.S.P.H., Tara Thomas-Gale, M.P.H., Deborah J Rinehart, Ph.D., Brandy Mitchell, A.N.P., W.H.N.P., Josh Durfee, M.S.P.H.
Objective: Describe strategies to increase the provision of comprehensive contraception services in a community health center setting, with emphasis on increasing access to and use of Long-Acting Contraceptives (LARC).
Significance: The ability to successfully plan pregnancies is an important component of overall health. Low income women have higher rates of unintended pregnancies, largely as a result of barriers to accessing effective methods of contraception, specifically LARC’s. Federally Qualified Health Centers (FQHC’s) provide health care for a largely low income population. However, according to a 2013 survey of health centers and family planning, there is wide variation in availability of contraceptive services, with only 19% of centers providing all methods on site.
Content: Denver Health is a vertically integrated safety net system which includes Denver Community Health Services (DCHS), a network of FQHC’s. In 2014 DCHS provided care to over 139,000 individuals, of whom over 32,000 were women of reproductive age (12 to 45), and 15,000 received family planning services. DHCS has had a Title X contract since 2004, which was significantly expanded in 2009 with support from an anonymous foundation through the Colorado Family Planning Initiative (CFPI). Among the resulting changes implemented were addition of family planning educators to the primary care teams, covering costs of LARC’s for uninsured women, implementing immediate post placental IUD and implant insertion, providing vasectomies, and training primary care providers in LARC insertion. We will review the impact that CFPI had on pregnancy rates in young women in Colorado since 2009, as well as on LARC utilization at Denver Health from 2012 to 2014. (A total of 8,693 LARCs , 2,335 in 2012; 2,964 in 2013; and 3,394 in 2014, an increase from 7.9% to 10.15% of eligible women. ) We will also discuss successful clinic based strategies to involve the entire health care team in the family planning services.