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2019 HSR&D/QUERI National Conference Abstract

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1114 — Engaging women Veterans through a Patient-Facing Web-based Reproductive Planning Decision Support Tool: A Pilot Study in VA Primary Care

Lead/Presenter: Lisa Callegari,  COIN - Salt Lake City
All Authors: Callegari LS (Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington Department of Obstetrics & Gynecology, Seattle ), Borrero S (Center for Health Equity Research and Promotion, University of Pittsburgh Department of Medicine, Pittsburgh), Arterburn DE (Kaiser Permanente Washington Health Research Institute, University of Washington Department of Medicine, Seattle) Magnusson S (Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington Department of Health Services, Seattle) Nelson, KM (Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington Department of Medicine, Seattle )

Objectives:
Although reproductive planning including contraceptive and preconception counseling can reduce unintended pregnancy and poor pregnancy outcomes, these discussions do not occur frequently in primary care. We pilot tested MyPath, a patient-facing web-based reproductive planning decision support tool, in VA primary care to assess acceptability, feasibility, and preliminary effect on outcomes.

Methods:
We performed a pilot study among Women Veterans scheduled for a visit with 8 primary care physicians (PCPs) at two VA Puget Sound Women's Health Clinics if they were aged 18-44 and desired discussing reproductive planning at their visit. A control group (n = 28) was recruited prior to and intervention group (n = 30) recruited after introduction of MyPath into clinics. Participants completed surveys in the waiting room before their visit and immediately post-visit. Intervention participants used MyPath after the pre-visit survey and before their visit. Acceptability and feasibility were assessed among intervention participants and PCPs by survey. Occurrence of reproductive planning counseling and changes in pre-post-visit knowledge, decisional conflict, provider-patient communication self-efficacy, and effective contraceptive use (pill, patch, ring, injection, implant, intrauterine device) among intervention and control participants were compared using T-tests, Chi-square or Fisher exact tests as appropriate.

Results:
Nearly all (97%) participants who used MyPath reported they learned new information and 93% reported they would recommend it to other Veterans. No PCPs reported that the tool significantly increased their workload. A greater proportion of intervention participants versus controls reported reproductive planning counseling in their visit (93% vs 68%;p = 0.02). Compared to controls, intervention participants experienced greater gains in knowledge (mean change +1.7 vs +0.2;p < 0.001) and provider-patient communication self-efficacy (mean change +0.8 vs +0.2;p = 0.02); a non-significantly greater increase in effective contraception (+13% vs +4%;p = 0.20); and similar reductions in decisional conflict (mean change -0.3 vs -0.2;p = 0.65).

Implications:
MyPath was highly acceptable to women Veterans and did not increase PCPs' perceived workload. Preliminary efficacy data suggest use of MyPath prior to visits may increase reproductive planning counseling and improve women Veterans' decision quality and contraceptive use.

Impacts:
MyPath is a scalable, patient-centered intervention with potential to improve reproductive planning services and health outcomes in VA. A larger randomized evaluation of effectiveness and implementation barriers and facilitators is warranted.