1. Improving Reproductive Management in an Integrated Health System: Contraception as a Vital Sign Diane Dailey, MD Kaiser Permanente, Northern California Adult Medicine

2. Reproductive Management Every Woman Every Time

3. Reproductive Health Initiative Objectives: –Optimize the health of reproductive age women members by using a reproductive life plan tool in Kaiser Permanente adult medicine departments –Improve patient knowledge regarding their reproductive risks in light of fewer visits to ob/gyn for cervical screening

4. Provider education for using a Reproductive Life Plan Tool Ask every woman: What are your Current reproductive health plans? Ensure and promote contraception where needed Recommend a daily multivitamin Develop a strategy for EVERY woman with an adverse birth outcome

5. Provider education for using a Reproductive Life Plan Tool Weeks following conception are a critical period of a baby’s development Universal approach will reduce risk factors that could impact future pregnancies

6. This is the Electronic Medical Record visit note page

7. The Medical Assistant charts routine vitals as per routine protocol

8. In the “History” tab we can document medical, surgical, family, social and specialty information

9. A subcategory of Social History is “substance and sexual activity”

10. Medical Assistant Workflow Medical assistant already completes the social history section at every visit for tobacco use as part of our tobacco cessation efforts Now for each woman age 15-50 she also completes the sexuality category questions

11. Medical Assistant Workflow What are you using so you don’t get pregnant? If not using any bc method, give patient “Birth Control Options” Handout If trying to get pregnant, give patient “Is a Pregnancy in Your Future” handout Do you have male partners? If yes Are you currently having sex? If yes

13. This is what the final screen looks like when completed

14. Information placed in “visit notes” for provider to review

15. Provider Workflow MD/NP should include diagnosis of reproductive management and date Identify contraceptive method in the annotation section if no method – what other measures are being taken (i.e. female partners, MVI/folate for preconception) Move the diagnosis into the problem list (this then can be viewed at all future contacts in any department)

16. Benefits to patient Using this reproductive life plan tool allows for clear documentation to: Easily confirm current plan with patient Avoid teratogenic medications or treatments

18. Reproductive Management Questions