Improving Documentation Rates of Contraception and Reproductive Planning in Patients With Rheumatic Disease

This study aimed to improve contraception and reproductive planning documentation within rheumatology providers' notes at a single academic center.

Female patients aged 18 to 45 years with autoimmune inflammatory rheumatic diseases were identified, and chart review was performed for documentation of contraception and pregnancy planning. Baseline data were collected from 148 charts between May 2022 and March 2023. In June 2023, a reproductive Health Assessment Questionnaire was integrated into the electronic health record and sent to patients for completion before their visits. Postintervention data were collected from 176 charts between July 2023 and December 2023. Demographics of patients (race, ethnicity, and sex) and provider sex were collected. Telehealth and face-to-face visits were assessed separately.

A statistically significant increase (P < 0.0001) was seen in provider documentation of both contraception (from 44.6 to 70.5%) and pregnancy planning (from15.5 to 60.2%) after implementation of the previsit questionnaire. When patients prescribed teratogenic medications were analyzed separately, there was statistically significant (P < 0.0001) better documentation of pregnancy planning after the intervention. Secondary analyses found that patient age, race and ethnicity, encounter type, and provider sex had no significant impact on documentation rates.

By integrating an electronic, previsit questionnaire into the patient portal, documentation was significantly improved for contraception and pregnancy planning. The results were sustained for six months. Further studies are needed to see if improved documentation translates into more effective reproductive health care discussions, referrals to gynecology, and subsequent improvement in reproductive health outcomes.