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Component 1.1

Timeliness of Care

Definitions

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.

Strategies

  • 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.

Resources

  1. U.S. Selected Practice Recommendations (SPR) for Contraceptive Use, 2013: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usspr.htm
  2. 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
  3. 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
  4. 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
  5. Institute for Healthcare Improvement (IHI): http://www.ihi.org/resources/Pages/Measures/ThirdNextAvailableAppointment.aspx