Remote intervention improves contraceptive counseling rates

Remote intervention improves contraceptive counseling rates | Image Credit: © nito - © nito - stock.adobe.com.

According to a recent study published in the Journal of Medical Internet Research, telephone-based intervention helps improve contraceptive counseling and prescription in individuals with a resolved pregnancy of unknown location.

A pregnancy of unknown location, defined as a pregnancy location not identified by ultrasound, is seen in up to 40% of pregnant patients. Patients with a pregnancy of unknown location often undergo follow-up through serial human chorionic gonadotropin (hCG) measurements. 

Measuring hCG is often performed remotely rather than in-person, leaving potential concerns such as contraception unaddressed. Contraceptive counseling is important for determining fertility desires and pregnancy prevention value.

Patients with a pregnancy of unknown location are often discharged from care through a telephone call, causing a unique need for family planning methods. To determine how a telephone-based intervention could improve contraceptive counseling in patients with a pregnancy of unknown location, investigators conducted a retrospective cohort study.

Participants had a resolved pregnancy initially presenting with a pregnancy of unknown location. Charts of patients were reviewed by the primary study author from October 2016 to October 2018. A telephone-based electronic medical record (EMR) intervention was implemented on October 31, 2017.

Eligibility criteria included presenting to the institution’s emergency department or outpatient office, initially having a pregnancy of unknown location, and having a documented resolution of pregnancy. Exclusion criteria included being lost to follow-up, having a final evaluation in-office, and being diagnosed with a viable intrauterine pregnancy or molar pregnancy.

The intervention included a standardized telephone script in the EMR, occurring when patients were discharged for hCG measuring. Topics discussed included patients’ final diagnosis and reproductive plans. If a patient was planning to prevent pregnancy, contraceptive options, prescription methods, and potential referral for a contraceptive appointment were also discussed.

Contraceptive counseling documentation of patients before the EMR intervention was introduced were compared to those of patients after the intervention was introduced. Any document discussing contraception at discharge from follow-up was considered contraceptive counseling documentation.

There were 100 women included in the preintervention group and 120 in the postintervention group. Baseline characteristics did not differ between participants. Unplanned pregnancy was reported by 60% of patients, planned by 33%, and uncertain by 7%. Desired pregnancy was reported by 70% of patients.

Contraceptive counseling was received by 27% of the preintervention group and 78% of the postintervention group. The EMR telephone prompt intervention was used in 79% of contraceptive counseling cases in the postintervention group.

In the preintervention group, 26% had a 6-month repeat pregnancy, of which 80.8% did not receive contraceptive counseling. These rates were 26% and 23% in the postintervention group respectively. 

Overall, the odds of contraceptive counseling and of receiving a contraceptive prescription were greater in the postintervention group. These results indicated increased contraceptive counseling from a telephone-based counseling intervention in patients with a resolved pregnancy of unknown location.

Reference

Flynn AN, Koelper NC, Sonalkar S. Telephone-based intervention to improve family planning care in pregnancies of unknown location: retrospective pre-post study. J Med Internet Res. 2023;25:e42559. doi:10.2196/42559