![[ Visit Client Website ]](images/banner.gif)
Background: 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.
Objectives: To create an electronic reminder system to identify patients eligible for FPS and measure FPS utilization, cost of integration, and patient/provider satisfaction.
Methods: Quasi-experimental design compared enrollment and patient/provider satisfaction before (2008) and after integration (2010). Time and cost were calculated for STD only and integrated FPS/STD visits in 2010. Incident pregnancy (12 months after initial visit) and STD rates (6 months after initial visit) before and after integration were explored. Quantitative and qualitative analyses were performed
Results: In 2008, 9,695 clients (males 5,842, females 3,853) and in 2010, 9,415 clients (males 5,653, females 3,762) were eligible for FPS. FPS enrollment increased from 51.6% in 2008 (males 53.3%, females 49.1%) to 94.5% in 2010 (male 93.9%, females 95.3%) (p<0.01). Using multivariate regression, additional staff time and cost for integrating FPS into the visit was 4.01 minutes and $3.57. Staff satisfaction increased and client satisfaction remained high with integration. Among those returning to the STD or Denver community health clinics within 12 months, pregnancies were lower among enrolled versus non-enrolled women for both 2008 (94/1124, 8.4% versus 86/417, 20.6%, p<0.01) and 2010 (195/1417, 13.8% versus 9/28, 32.1%, p<0.01). No difference found in incident gonorrhea or chlamydia infection (p=NS).
Conclusions: Integration of FPS with STD services is feasible, increases costs minimally and may be more time-efficient than offering separate services. Integration may reduce pregnancy rates but did not affect STD rates.
Implications for Programs, Policy, and Research: Combining pregnancy and STD prevention activities within a single clinic visit using an integrated charting system that identifies need for FPS within the context of STD clinical services offers an affordable, efficient and well-accepted approach for addressing sexual health.