Increasing Reproductive Health Counseling and Screening in a Pediatric Rheumatology Clinic Through Involving Diverse Group of Stakeholders and Applying Quality Improvement Principles
A multidisciplinary quality improvement initiative at Albany Medical Center utilizing Plan-Do-Study-Act cycles and diverse stakeholder engagement significantly increased documented reproductive health counseling for pediatric rheumatology patients on teratogenic medications, though the increase in pregnancy screening did not reach statistical significance.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many young people living with chronic rheumatic diseases, managing their health means taking powerful medications that control inflammation and pain. However, some of these essential drugs carry a hidden danger: if a patient becomes pregnant while taking them, the medication can cause severe harm to a developing baby, leading to miscarriage or birth defects. This creates a critical need for doctors to have open, honest conversations with their teenage and young adult patients about sexual health and family planning. Yet, despite the clear risks, these conversations often do not happen. Many young patients lack knowledge about how their medicines affect pregnancy, and doctors sometimes hesitate to bring up the topic due to time limits or uncertainty about the best way to discuss it. Bridging this gap is vital, because while young people with chronic illness are just as likely to be sexually active as their peers, they often do not receive the specific guidance they need to stay safe.
At the Albany Medical Center Pediatric Rheumatology Clinic, a team of doctors, nurses, pharmacists, and community members decided to tackle this problem directly. They launched a quality improvement project designed to change how the clinic operates, with a single, clear goal: to significantly increase the number of patients who receive counseling about reproductive health and screening for pregnancy before they are prescribed these risky medications. The team did not rely on a single fix; instead, they brought together a diverse group of stakeholders, including patient and parent representatives, to redesign the entire workflow. They used a method of testing small changes, measuring the results, and refining their approach, a process that allowed them to learn quickly what worked and what did not.
The project began by looking at the current state of affairs in the clinic. A review of patient records revealed a stark reality: before any changes were made, only one out of thirty-two patients on these medications had any record of receiving reproductive health counseling. Similarly, only two out of twenty eligible patients had been screened for pregnancy. The team knew that simply telling doctors to "do better" would not be enough. Their first major step was to educate the five providers in the clinic, teaching them the latest guidelines on how to discuss these sensitive topics and explaining the specific safety requirements for certain medications. They also created a digital tool within the electronic health record system, a pre-written text block that made it much faster and easier for doctors to document these conversations. After this initial round of training and tools, the number of patients receiving counseling rose to twenty-three percent, and pregnancy screening jumped to twenty-four percent.
Encouraged by this progress but knowing there was more work to do, the team moved to a second phase. They realized that even with training and better tools, the busy nature of a clinic visit could cause these important conversations to be forgotten. To solve this, they changed the workflow itself. Before a patient even arrived for their appointment, a member of the nursing team would review the schedule and flag any patient who needed reproductive health counseling. This acted as a gentle, visual reminder for the doctor, ensuring the topic was not overlooked in the rush of the day. This simple addition of pre-visit planning had a profound effect. By the end of the second phase, the rate of documented counseling had climbed to forty-one percent, and pregnancy screening reached thirty-four percent. The increase in counseling was statistically significant, meaning it was a real improvement and not just a random fluctuation. While the increase in screening was also positive, the data suggested it might take more time or different methods to reach the same level of statistical certainty.
Beyond the numbers, the project revealed something important about the doctors themselves. Before the training, the providers knew the basics, but after the educational sessions, their confidence and knowledge scores improved. More importantly, every single provider agreed that discussing reproductive health with young patients was extremely important. The team also learned that the way they approached the conversation mattered. Patient and parent representatives on the team helped create a suggested framework for how to talk about these issues, ensuring the discussions felt natural and supportive rather than clinical or awkward. They also identified barriers that had been invisible to the medical staff, such as language differences and the need for quick reference guides that doctors could glance at during a visit.
The success of this initiative shows that when a medical team listens to a wide range of voices—from the doctors and nurses to the patients and their families—they can build a system that protects vulnerable young people more effectively. The project did not just add a new rule; it wove safety into the daily rhythm of the clinic. By combining education, better tools, and a simple reminder system, the team turned a gap in care into a standard part of treatment. While the work is not finished, and the team plans to expand these practices to adult patients and refine their materials further, the results offer a clear path forward. It demonstrates that with the right support and a willingness to change how things are done, clinics can ensure that every young person receives the care they need to manage their health safely, regardless of their future plans for starting a family.
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