By Melissa Benavides, MD
There is tremendous need across the state of Texas for increased access to women’s health services. As a physician representing the TAFP on the Texas Women’s Healthcare Coalition, I would like to remind my colleagues that family physicians are well positioned to fill this void. Even some of the smaller, more remote towns throughout our state are served by dedicated family physicians who have equipped themselves to provide convenient, wide-ranging women’s health services. As many patients prefer and trust their family physician, we are well-positioned to make positive impacts on the health status of women and children throughout Texas.
I would like to address two major steps we can take as family physicians to improve the availability and convenience of women’s health services in our state.
First, we can ask all female patients of child-bearing age One Key Question: Would you like to become pregnant in the next year?
The One Key Question campaign was developed by the Oregon Foundation for Reproductive Health to spark conversations about reproductive health among providers and patients. For more information, visit https://www.marchofdimes.org/materials/one-key-question-overview.pdf.
Based on the patient’s answer to this critical question, family physicians can proactively support women who desire to become pregnant with preconception counseling, recommending folic acid and alcohol avoidance as well as addressing chronic medical conditions prior to pregnancy. If a patient is not ready to become pregnant, we can assist her with contraception so that she can prevent pregnancy if she is not financially, emotionally, or physically ready.
Second, while most family physicians are comfortable prescribing birth control pills, patches and injections, many do not yet offer long-acting reversible contraception. LARCs, which include implantable devices such as Nexplanon, and IUDs, are some of the most effective forms of birth control available. When given the option, many patients will choose LARCs as a more reliable, sustained way of preventing unplanned pregnancy. By both 1) asking patients’ their plans for pregnancy and 2) offering LARCs within our clinics, family physicians can achieve widespread positive impacts. For example, the state of Colorado reduced their teen pregnancy rate by 50 percent and their abortion rate by 50 percent by offering LARCs for free and improving access.
These two changes are fairly easy to implement, as most family physicians are trained in insertion during residency and LARC procedures are easy to perform within our offices. Even if you have not offered LARCs in your own practice or maintained your skills, training programs are available to guide effective clinical implementation so that you can play a role in increasing access to women’s health services across Texas.
Let me share a personal example. I work for Crossover Health, an innovative employer-sponsored health care organization that partners with corporate clients to serve as the preferred medical home for their employees, and in some cases, dependents. My local Crossover Health center decided to offer LARCs to our patients last year. To prepare for the new offering, our family physicians took a Nexplanon training class taught by Merck (which is required by Merck to place an order for Nexplanon) and honed our IUD skills at courses provided during the September 2017 Family Medicine Experience conference in San Antonio. By November 2017, we were able to offer LARCs to our patients.
By starting with the One Key Question — asking about desire for pregnancy or contraception — at our female patients’ preventive care visits, and advising them that we offer LARCs, we have seen tremendous demand. Patients have been very pleased with this service, and because we strive to serve as our patients’ preferred medical home, many have positively remarked on the experience of having the procedure performed by their own physician instead of being referred out. Based on the demand we have seen locally, we hope to offer LARCs at all of our Crossover Health centers in Texas and the rest of the country to provide our patients with convenient, accessible care from their most trusted providers.
If you are interested in positively improving women’s health services across Texas, there are several ways to get started. Both the TAFP and AAFP offer IUD training courses at conferences throughout the year. Nexplanon training has to be arranged directly through Merck. They may be willing to offer a course in a remote area if physicians ask for it. Additionally, LARCs are reimbursed by many private insurers without additional out of pocket cost to the patient due to the ACA. They are also covered by Medicaid and the Healthy Texas Women program.
By asking all female patients of child-bearing age about their reproductive plans at least yearly, and offering a full range of contraceptive options including LARCs, family physicians can help reduce unplanned pregnancies and positively improve the accessibility and convenience of women’s health services across Texas.