Improving preconception care

OBJECTIVE: To improve the documentation and delivery of preconception cave to all women of reproductive age attending an inner city hospital's outpati ent gynecology clinic. A secondary goal was to evaluate the knowledge and a wareness of providers regarding preconception care. STUDY DESIGN: A preintervention chart review of a convenience sample of non pregnant women with reproductive potential who attend an inner city hospita l gynecology clinic (n=100) was conducted to evaluate delivery of preconcep tion cave. Items screened for included: family planning services, domestic violence, nutrition and medical risk factors, medication use, appropriate c ounseling and use of referral services. All providers in the clinic were su rveyed to assess their knowledge of and attitudes toward preconception care . A two-part intervention was then carried out: (1) a one-hour lecture for all providers, and (2) a standardized preconception cave form inserted in a ll charts. A postintervention chart review of a second convenience sample ( n=100) and repent provider survey were then conducted to evaluate the effec tiveness of the two interventions. RESULTS: Following the two-pronged intervention, there was evidence of impr oved documentation of the delivery of preconception care. Documentation of screening in almost all categories tons significantly improved (P<.05). The greatest improvements were noted in complete screening for medical risk fa ctors (from 15% to 44%),for over-the-counter and prescription medication us e (from 10% to 70% and 30% to 77%, respectively), domestic violence (from 1 0% to 57%) and nutrition (from 9% to 50%). However, provider knowledge of a nd attitudes toward preconception care were not significantly changed. CONCLUSION: The combination of education about preconception care and inser tion of a standardized form into a patient's chart led to a clear improveme nt in the documentation of preconception care. Given the significance of pr econception care, insertion of a standardized form should be considered to help providers deliver complete and appropriate care to their patients.