Article Figures & Data
Figures
- Figure 1.
Participant recruitment flowchart.
Tables
- Table 1.
Sociodemographic and Clinical Characteristics of Participants Overall and by Completion of FRAME™ Virtual Coaching and Discussion of Assessment with Physician
Characteristic All ParticipantsN = 46 Completed Virtual Coaching Discussed Assessment with Physician YesN = 34 NoN = 12 P-value YesN = 24 NoN = 22 P-value Age in years Mean, age ± SD 31.5 ± 5.9 31.4 ± 6.0 31.7 ± 5.8 0.911 32.1 ± 5.9 30.9 ± 6.0 0.489 Age group 21 to 29 years 17 (37%) 14 (82%) 3 (18%) 0.489 12 (71%) 5 (29%) 0.053 30 to 40 years 29 (63%) 20 (69%) 9 (31%) 12 (41%) 17 (59%) Education level High school or less 11 (24%) 7 (64%) 4 (36%) 0.425 3 (27%) 8 (73%) 0.055 Some college or more 33 (72%) 26 (79%) 7 (21%) 20 (61%) 13 (39%) Missing 2 (4%) Racial/ethnic group Non-Hispanic Black 21 (46%) 11 (52%) 10 (48%) 0.027* 10 (48%) 11 (52%) 0.668 Non-Hispanic White 13 (28%) 12 (92%) 1 (8%) 7 (54%) 6 (46%) Non-Hispanic Other 5 (11%) 5 (100%) 0 (0%) 4 (80%) 1 (20%) Hispanic, Any race 7 (15%) 6 (86%) 1 (14%) 3 (42%) 4 (58%) Insurance type Public 12 (27%) 6 (50%) 5 (50%) 0.052 3 (33%) 9 (66%) 0.044* Private 34 (73%) 28 (82%) 6 (18%) 21 (62%) 13 (38%) Prior births None 32 (70%) 27 (84%) 5 (16%) 0.027* 20 (63%) 12 (17%) 0.034* One or more 14 (30%) 7 (50%) 7 (50%) 4 (29%) 10 (71%) Chronic conditions Mean, number ± SD 2.0 ± 1.5 2.2 ± 1.5 1.3 ± 1.3 0.069 2.3 ± 1.6 1.6 ± 1.3 0.093 Any chronic condition Yes 37 (80%) 29 (78%) 8 (12%) 0.211 21 (57%) 16 (43%) 0.276 No 9 (20%) 5 (56%) 4 (44%) 3 (33%) 6 (66%) Prescription medications Yes 22 (48%) 17 (77%) 5 (23%) 0.619 12 (55%) 10 (45%) 0.758 No 24 (52%) 17 (71%) 7 (29%) 12 (50%) 12 (50%) ↵*Indicates statistically significant at α = 0.05.
Abbreviation: SD, standard deviation.
- Table 2.
Participant Confidence and Literacy Around Discussing Fertility Health – From Baseline to Immediately Post-Coaching (29 Respondents)
Participant Confidence and Literacy Score On a Scale of 1-10, in Which 1 is Not at All Confident and 10 is Very Confident, How Confident Are You… …in Talking with Your Provider about Your Fertility? …in Understanding Factors That Impact Your Fertility? Baseline score 6.4 5.9 Post-coaching score 9.2 8.4 Pre-post change in score No. (%) with pre-post increase 23 (79%) 19 (66%) No. (%) without change 6 (21%) 10 (34%) No. (%) with pre-post decrease 0 (0%) 0 (0%) THEME: Gain in Knowledge My coach was very knowledgeable. My coach gave me good advice. She offered real time, attainable information and suggestions. I was able to learn many new things and have my questions answered. During the coaching session, a lot of factors were explained and my questions answered. The process was thoroughly explained and I understand the following next steps. I felt incredibly informed. THEME: Connected on Personal Level My coach and seemed to understand some of the concerns I had. My coach is the best! She was excellent in creating a warm, informative, non-judgmental environment for me to share my reproductive goals. We also connected on a cultural level, which I appreciated and valued. She is very attentive, helpful, and willing to do things in an alternate format (text and phone instead of e-mail). I think my coach was a great coach with a lovely attitude and very personable. I felt heard and respected. THEME: Linked with Resources or Motivated Action I am satisfied with the work my coach and I did together because she was very detailed and thought outside the box. What was especially nice was although we spoke about women’s health, I was also able to talk about other health concerns of mine. My coach was even able to assist me in finding a therapist to help me work through some mental health struggles as well. I felt empowered after our call and also called to make some steps toward making space in my life for expanding my family in the future if I choose to do so. - Table 4.
Patient-Reported Activities or Change Following Discussion of FRAME™ with Physician (24 Respondents)
Activity or Change Number (%) Improved lifestyle 13 (54%) Increased physical activity
11 Improved diet
10 Plan to lose weight
9 Reduce alcohol
3 Reduce marijuana
2 Reduce tobacco
1 Began taking prenatal vitamin 10 (42%) Looked into benefits and coverage 10 (42%) Had conversation with partner 8 (33%) Scheduled additional physician visit 8 (33%) Adjusted medications 7 (29%) Adjusted birth control 7 (29%) Changed timing of planned childbearing 6 (25%) Began tracking ovulation 5 (21%) Pursued additional fertility testing or work-up 4 (17%) Discussed chronic condition management with provider 3 (12%) Began trying to conceive 3 (12%) Pursued egg preservation 1 (4%) - Table 5.
Physician Responses About Extent of Agreement with Statements About FRAME™ (23 Respondents)
Statement Strongly Agree Agree Neither Agree/Disagree Disagree Strongly Disagree Helped me provide the best care possible 7 (30%) 9 (40%) 7 (30%) 0 0 Made the visit more efficient 4 (23%) 13 (57%) 6 (26%) 0 0 Made my patient more engaged in care 9 (39%) 11 (49%) 4 (23%) 0 0 Improved clinical outcomes 2 (9%) 9 (39%) 12 (52%) 0 0 Helped patient be healthier 4 (23%) 15 (65%) 4 (23%) 0 0 Helped patient be better informed 11 (49%) 8 (35%) 4 (23%) 0 0 Enhanced quality of the visit 10 (44%) 9 (39%) 4 (23%) 0 0 - Table 6.
Physician Narrative Responses Following FRAME™ Discussion with Patients, Organized by Theme
THEME: Patient Motivation or Opportunity Patient was motivated to discuss preconception and family planning. This patient came to the appointment more motivated than in previous visits, and specifically interested in learning more about WHY she has experienced irregularities in her periods/dysfunctional uterine bleeding. We were finally able to focus our attention on this problem and do a more thorough work-up. Also, she was interested in her family history (which includes sickle cell disease) and understood the importance of preconception visits for testing when she is ready to have a family. She also seems to understand and be more motivated to address these topics. THEME: Providing an Opening or Opportunity It was very helpful to go through the patient's complicated psych regimen to help her understand how critical it would be to involve her psychiatrist with changing medications before she becomes pregnant in the future. We were also able to identify some red flags with the patient's menstrual cycle so that she could be aware that coming off birth control in advance of desiring pregnancy and tracking her cycle to ensure ovulation and assess for other diagnoses could be a helpful step. This patient, by participating in FRAME™, was more ready/willing to discuss her weight (being obese) and to begin to address lifestyle factors for reducing her weight to a healthier value to improve her fertility and future pregnancy outcomes. Before this visit she had been reluctant/opposed to such discussions. The FRAME™ evaluation was extremely helpful in evaluating this patient and facilitated a thorough preconception evaluation including ordering lab work and an endometrial biopsy for a problem identified. We were also able to identify some fertility risk factors and provide education on fertility expectations and advice for trying to conceive, as well as lifestyle modifications that will be important to optimize fertility. The patient was extremely appreciative of the thorough care she received. The information provided by FRAME™ helped me to understand my patient's family planning goals so that we were able to have a discussion about PCOS lifestyle modifications to improve fertility, obtained fasting insulin and discussed possibly starting metformin to restore ovulatory function, and we discussed her prior OCP and unwanted side effects so we were able to find an alternative for now while she is not actively trying to conceive, as this could help us treat her iron deficiency (also important before pregnancy) and prevent endometrial cancer. THEME: Clinical Efficiency It didn’t slow the encounter at all, actually helped me understand high priority items and their family planning goals, helped take off a bit of me. I felt like it made me more efficient as it made my conversation more ….efficient, impactful, efficacious This visit was a great example of how FRAME™ can help us to incorporate comprehensive preconception care for eligible women into an annual physical visit. Fertility is something that is not always touched on in an annual physical, but that may be the opportunity for preconception care with many patients. In this patient's case, she had vitamin D deficiency which is now being corrected to optimize fertility, and we were able to discuss optimal timing on how to try to conceive and identify the fertile window, as well as additional labs we could get as part of preconception care – all without adding too much time to her annual visit. THEME: Personalization This may seem like a small thing but it is huge that even the assessment “looks pretty and nice” when these patients aren't used to this type of attention to detail and personalization, considering their income and what they can afford in the world of healthcare. FRAME™ is providing care for these Emory patients in a unique and special way, specifically considering that many of them are on Medicaid and typically will just get a packet of papers handed to them on government services. What they are used to is very different from the personalized care that FRAME™ is offering. Framing the Preconception Health Risk Assessment and Counseling to Patients Framing the program around reproductive health promotion, rather than pregnancy or fertility planning, is important in helping patients view preconception health risk assessment and counseling as of relevance to them. Communication with Patients to Arrange Pre-Encounter Completion of Risk Assessment and Coaching A direct line of communication to the coordinator team, via Google voice and patient portal messaging, is important for timely, direct communication to allow for optimal scheduling of the components of the intervention. An automated way for notifying the coordinator team of patient-initiated changes in scheduled appointments (such as through the electronic medical record system) can contribute to optimal ordering of the components of the intervention. Prompting Health Care Provider to Access and Review the Preconception Health Risk Assessment An automated way for notifying the health care provider of the availability of the preconception health risk assessment summary, and in supporting the health care provider to review the summary via a link within the electronic medical record, can contribute to clinical efficiency.
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.