Ling Protocol #5: Reproductive health for adolescents with rheumatic diseases taking teratogenic medications

Ling Protocol #5: Reproductive health for adolescents with rheumatic diseases taking teratogenic medications

by Nicole Ling -
  1. A.     Describe one tool that you will employ in your intervention strategy using the following domains.

(sorry, I wrote two – one for the more immediate, one projected/anticipated tool)

  1. Tool—type: In depth individual interview
    1. Target Population: Pediatric Rheumatologists
    2. Target Behavior:  Increase provision of reproductive health care for adolescents with rheumatic disease taking teratogenic medications (class D or X).
    3. PRECEDE Category: Predisposing factors, increase awareness of gap in care, identify barriers and facilitators to provision of care to then and inform guidelines for provision of reproductive health care for these patients.
    4. Platform:  Publication in academic journal coupled with poster/presentation at national conference. (written materials and in person discussion) 
  1. Tool—type: In person decision support and multidisciplinary delegation of tasks.
  2. Target Population: Pediatric Rheumatology Clinic (rheumatologists, allied health care providers and specialty clinic administration)
  3. Target Behavior:  Increase provision of reproductive health care for adolescents with rheumatic disease taking teratogenic medications (class D or X).
  4. PRECEDE Category: Enabling factors: need an intervention that will make provision of care easier to do and streamlined
  5. Platform:  In-person contraception education, counseling and possible prescription by dedicated PNP in rheumatology clinic (built into each clinic visit for a female teen on teratogenic medication that we (rheumatologists) have prescribed. 

B. For a multi-tool intervention strategy, use the PER worksheet attached to describe how you will address each of the PRECEDE framework components (Predisposing, Enabling and Reinforcing).

 I think this would be a great framework to use when I code my qualitative, individual interviews with pediatric rheumatologists and primary care providers to target areas for intervention!

 

Target Behavior

Increase provision of reproductive health care for adolescents with rheumatic disease taking teratogenic medications (class D or X)

Target Audience

Pediatric Rheumatologists and allied health providers in Pediatric Rheumatology Clinic

Other Key Individuals

Patients, primary care providers

PREDISPOSING

ENABLING

REINFORCING

KNOW

BE ABLE TO DO (skills)

REMINDED

Which medications are teratogenic?

Discuss sexual health and family planning with adolescents in a confidential manner.

Alert in EHR for teratogenic medications

Based on the individual and their diagnosis, what are the options, side effects and monitoring available for contraception?

Identify appropriate methods of pregnancy prevention.

Alert in HER when teratogenic med is on active med list and contraception is not listed

BELIEVE/VALUE

ACCESS TO

POSITIVE REINFORCEMENT

Pregnant pt with rheumatic disease have poor outcomes. Additionally, outcomes are even worse when they are taking teratogenic medications.

Resources to other providers for family planning and contraception (ie. implenon, IUD’s etc)

Dashboard display in EHR when issue is documented to be addressed (like meaningful use checklist)

I CAN work within this medical system to provide and AM responsible for providing reproductive, confidential care to my patients.

Parents (some) and involved primary care providers

Appreciative teens/patients

INTENTION

ACCESS REMOVED

NEGATIVE REINFORCEMENT

To counsel all patients on teratogenic medications

Time constraints in clinic visits

Dashboard display in EHR (if suboptimal documentation/performance) when compared to peers

To offer long term contraceptive options for teens that are or may become sexually active

Lack of reimbursement for extra effort/time

Pregnant teens/patients

To prevent unintended pregnancy in the population

Parents (some)

SOCIAL SUPPORT

 

Difficulty when trying to reach other medical care providers for the patient

Other providers in division/ancillary health staff.

Re: Ling Protocol #5: Reproductive health for adolescents with rheumatic diseases taking teratogenic medications

by Victoria Tang -

Such important work. For social support, I bet you can create a national rheumatologist interest group that can support each other in "doing the right thing" and endorse the need to provide contraception/education to their peers at local and national. Re: dashboard display, would that be placed in the clinic or could it be a national eval list like the hospitalcompare website that medicare has.

Re: Ling Protocol #5: Reproductive health for adolescents with rheumatic diseases taking teratogenic medications

by Lindsay Hampson -

Nikki - 

Really like the dashboard idea to give providers feedback. I think this could be very helpful to instill a sense of competition in providers to do this. Also helps get people on the bandwagon when they know that everyone else is doing it :)

Re: Ling Protocol #5: Reproductive health for adolescents with rheumatic diseases taking teratogenic medications

by Lisa Thompson -

This project is looking great. I like Vicky's idea of a national Rheumatologist movement to improve access to contraceptives. When you said you would use the PER framework to code interviews, did you mean you would use this framework to develop the interview guide? I think that would be an excellent use of the PER worksheet and underlying theoretical constructs.