Implementation of a reproductive goals SmartForm to improve contraception and preconception counseling in an internal medicine resident clinic

Objectives: While internal medicine residents agree on the importance of reproductive counseling, time and knowledge constraints often inhibit counseling. One Key Question (OKQ) is a pregnancy intention screening tool that can facilitate counseling. We implemented a screening tool based on OKQ with the primary aim of increasing residents’ reproductive counseling; secondary outcomes included rates of contraception prescriptions and gynecology referrals. Materials and Methods: The quality improvement study was conducted in an internal medicine resident clinic within a safety-net health system. We included women ages 18–49 with reproductive capability. Our primary intervention was an electronic medical record (EMR) tool based on OKQ (Reproductive Goals SmartForm) and a prescribing tool (Contraception SmartSet). We conducted surveys to assess the usability of the tools. Pre- and post-intervention, we surveyed residents on their counseling habits and compared the results via Chi-square tests. Results: The SmartForm was completed on 27% of eligible patients. Compared to the prior 9 months, there was an increase in contraception and emergency contraception prescriptions and gynecology referrals. There was a statistically significant change in residents’ subjectively reporting routinely asking their female clinic patients of reproductive age about their reproductive goals or desire to get pregnant ( p = 0.001), considering their reproductive status when starting or continuing medication ( p = 0.047), and counseling on contraception ( p = 0.023). Conclusion: To our knowledge, this is one of the first studies on implementing OKQ in an internal medicine resident clinic. The improvement in reported counseling practices suggests that a clinic-based EMR screening tool can enhance resident reproductive counseling.