Integration of family planning services into a sexually transmitted disease clinic setting

摘要

BACKGROUND: Sexually transmitted diseases (STDs) and unintended pregnancy are significant and costly public health concerns. Integrating family planning services (FPS) into STD visits provides an opportunity to address both concerns simultaneously. Our objectives were to create an electronic eligibility reminder to identify male and female patients eligible for FPS during an STD clinic visit and measure FPS use, additional cost of integrated services, and patient/provider satisfaction and to explore the impact on incident pregnancy and STDs. METHODS: Quasi-experimental design compared enrollment and patient/provider satisfaction before (2008) and after implementation (2010). Incident pregnancy and STD 12 months after the initial visit before and after were explored. Time and cost were calculated. Quantitative and qualitative analyses were performed. RESULTS: A total of 9695 clients (male, 5842; female, 3853) in 2008 and 10,021 clients (male, 5852; female, 4169) in 2010 were eligible for FPS. Enrollment in FPS increased (2008: 51.6%, 2010: 95.3%; P < 0.01). Total additional cost was US$29.25/visit, and additional staff time was 4.01 minutes for integrated visits. Staff satisfaction increased and client satisfaction remained high. Among women returning within 12 months (39.6% in 2008, 37.1% in 2010), pregnancies were lower among enrolled versus nonenrolled women for 2008 (7.7% vs. 19.5%, P < 0.01) and 2010 (13.1% vs. 25.9%, P = 0.05). Incident STDs did not differ. DISCUSSION: An electronic eligibility reminder of FPS increased FPS use. Integration of FPS with STD services is feasible, is well accepted, and increases costs minimally. Integration may reduce pregnancy rates without increasing STD rates.