Quick start protocols for contraception initiation:
refers to the initiation of contraception on the day of the visit.
Third next available appointment:
refers to the average length of time in days between the day a patient makes a request for an appointment and the third next available appointment. The third next available appointment is used rather than the next available appointment because it is a more sensitive reflection of true appointment availability.
- Reduce unnecessary barriers and facilitate same-day access to and successful use of contraceptives.
- For example, do not require a negative chlamydia test result prior to inserting an IUD or a Pap test/pelvic exam in asymptomatic women wanting oral contraceptives.
- Follow the Centers for Disease Control and Prevention’s (CDC) U.S. Selected Practice Recommendations (US SPR) for Contraceptive Use to determine the appropriate initiation and use of specific contraceptive methods.1
- Use the “quick start” method to provide patients with protection from unplanned pregnancy faster and more reliably.2
- Develop written policies that include directions for phone staff to ask patients if they need a same-day appointment.
- Establish a process to schedule these appointments as requested.
- Ensure clinic workflows accommodate appointments for patients with urgent needs, including double booking as needed.
- Consider maintaining at least 10% of the average number of daily appointments unfilled at the start of the business day based on an audit of a representative sample.3,4
- Assess and understand the patterns of both demand (i.e., daily number of patient requests for appointments) and supply (i.e., clinical resources/members of care team available to the clinic) in clinical practice.
- Adjust supply based on fluctuations in demand.
- Use team members to expand access by having them provide all intake and education. Use medical providers only as needed for top-of-license work.
- The Institute for Healthcare Improvement (IHI) measures access to care as the average length of time in days between the day a patient makes a request for an appointment and the actual appointment.5
- See Domain 2. Service Provision: Component 2.6: Contraceptive Supplies, for information on stocking birth control methods on-site.
- U.S. Selected Practice Recommendations (SPR) for Contraceptive Use, 2013: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usspr.htm
- Association of Reproductive Health Professionals, Quick Reference Guide for Clinicians, Choosing a Birth Control Method: https://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/Initiation-Hormonal-Contraceptives
- Providing Quality Family Planning Services (QFP), Recommendations of CDC and U.S. Office of Population Affairs, 2014, page 26: http://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf
- Oregon’s Patient-Centered Primary Care Home Program, 2014 Recognition Criteria; Technical Specifications and Reporting Guide, page 26:http://www.oregon.gov/oha/pcpch/Documents/ TA-Guide.pdf
- Institute for Healthcare Improvement (IHI): http://www.ihi.org/resources/Pages/Measures/ThirdNextAvailableAppointment.aspx