Non-Delayed Access: Establishing a Same Day Walk-in Contraception Clinic for Active Duty Women and Military Spouses
Ludrena, Rodriguez, DNP, WHNP-BC, RNC-OB, C-EFM; Callie M. Cheese, DNP, FNP-BC, WHNP-BC, Faculty Advisor; Luiz F. Correa, DO, Preceptor
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Purpose: The overall goal of the quality improvement initiative is to explore the feasibility of removing access barriers for contraception in active duty service members and their beneficiaries in an Army gynecology clinic.
Summary: A multidisciplinary team developed and implemented a same day walk-in contraception clinic with the intent to offer services one day per week with one healthcare provider and medical assistant allotted for staffing. The team utilized an individualized approach by screening patients for risk factors reflected in the medical eligibility criteria. Patients completed a user-friendly triage form and submitted a urine sample awarding the providers reasonable certainty of negative pregnancy status. Commercially prepared materials were available and used for patient education.
Outcomes: The clinic opened in November 2018. During the four-week pilot, thirty active duty service members and dependents received comprehensive education and counseling prior to initiating contraception. The project aim to improve-healthcare access is evidenced by 100% of respondents stating a belief that access to contraception was enhanced through the implementation of the same day walk-in clinic. The majority of the walk-in patients received the LARC method (78.9%), with the Etonogestrel implant (42%) being the most common. The average reported wait time was less than one hour with 100% respondent acceptance. The influx of patients during the first month resulted in full adoption of the program and offering walk-in services four days per week instead of one. Referrals for contraception initiation decreased from 6-8 weeks to none.
Implications: Almost half of the pregnancies in the U.S. are unintended. Military service members are not immune to these alarming statistics. Offering a same day option removes barriers such as a two-visit process for contraception initiation and decreases clinic referrals thus opening appointments for critical patients. The same day option improves military operational readiness, increases patient and staff satisfaction, and promotes family planning autonomy for service members. Additionally, the clinic serves as a training platform for residents, nurse midwives, and nurse practitioners, with 20 providers trained on device insertion and removal to date. Further research is required to determine the feasibility of a same day walk-in contraception clinic in comparable military settings.
Same Day LARC;
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