National Survey of Pediatric Sickle Cell Providers on Their Contraceptive Practices for Female Patients

Introduction: Pregnancies of women with sickle cell disease (SCD) have increased risk of morbidity and mortality, with potential additional complications due to uncertain teratogenicity of hydroxyurea and the newer medications. Unintended pregnancy is common among adolescents and young adults (AYA). We aimed to assess the beliefs, practices and barriers of U.S. pediatric hematology providers related to contraception for female AYA with SCD, as little is known about this topic. Methods: We developed a 25-question, web-based survey guided by the Health Belief Model to assess pediatric SCD providers' contraceptive perspectives and practices. Most questions were adapted from published surveys assessing provider views and practices on contraception for general AYA care or patients with other chronic health conditions. The survey was distributed from December 2020-April 2021 to licensed U.S. prescribers who provided care to female SCD AYAs ages 12-21 years within the prior two years. The anonymous survey was distributed by two methods: (1) a list of 526 pediatric SCD and/or general hematology providers from the HRSA SCD Treatment Demonstration Program Regional Collaborative, cross-referenced for reminder emails to 126 providers using a list from the HRSA Regional Genetics Collaborative (https://www.hrsa.gov); (2) directors from all 74 U.S. ACGME-accredited Pediatric Hematology-Oncology fellowship programs, asking then to forward the survey to their SCD providers. Surveys with >50% completion were analyzed using descriptive statistics and chi square analyses. Results: Of 177 respondents, 160 surveys met inclusion criteria and were analyzed: 73 (45.6%) contacted by emails and 87 (54.4%) contacted via the fellowship directors (Table 1). Respondents recruited via fellowship program directors were more frequently NP/PAs (total of 30 (18.7%)), of younger age (total 103 (64.4%) and had fewer years in practice compared to those contacted directly. The majority of providers reported counseling (76.9%) and/or referring patients for contraception (90.9%), but not prescribing (41.8%). Practices regarding contraception differed by provider characteristics (Table 2). Trainees vs. established providers less frequently reported counseling about contraception (54.1% vs. 84.6%, p<0.001). Overall however, younger vs. older providers (<45 years), did not differ in contraceptive counseling (75.7% vs. 80.7%, p=0.7). Motivators for providing counseling differed by certain demographics (data not shown): female providers more frequently counseled about contraception when patients disclosed being sexually active (87.0% vs 66.7%, p=0.046); NPs/PAs more frequently counseled if standards for counseling were in place (45.5% vs 22.0%, p=0.03); and providers with more years in practice when they had concerns about SCD patients' increased pregnancy risks (43.1% vs 23.9%, p=0.03). Provider practices did not differ by region or size of SCD practice. Providers who believed that hydroxyurea causes increased risk of pregnancy complications more frequently reported prescribing contraception (48.8% vs. 31.7%, p=0.04), but did not differ by counseling or referral practices. Concerns about teratogenic risk of hydroxyurea was not significantly associated with provider practices. The most frequently reported barriers for counseling (>30% respondents) were insufficiencies in time, patient/parent willingness, formal training, knowledge/ability and/or professional guidelines. Concerns about side effects was a barrier to prescribing (34.2%), while lack of access to providers with contraceptive expertise was the most common barrier to patient referral (34.9%). Multivariate analyses are ongoing. Conclusions: To our knowledge, this is the first national report of pediatric hematology providers' beliefs and practices regarding contraception for female AYA with SCD. While providers generally felt responsible for offering counseling and referral but not prescribing, practices varied based on certain provider characteristics, beliefs and perceived barriers. Clinical guidelines, improved provider education and training, and patient/parent decision Figure 1 Figure 1. Disclosures Smith-Whitley: Global Blood Therapeutics: Current Employment. Strouse: Takeda: Consultancy.

Adding a Seat at the Table: A Case Study of the Provider's Perspective on Integrating Community Health Workers at Provider Practices in California

Blue Shield of California's Community Health Advocate Program was created to support whole person-health needs by helping individuals of all socio-economic statuses navigate and access community resources, social services, and medical systems. Blue Shield's Health Reimagined team is partnering with medical providers, community resources centers, and community partners to provide intensive person-centered and technology-enabled care to patients, ensuring social needs are met while promoting health equity. A key aspect of the Health Reimagined initiative embeds Community Health Advocates (CHAs) within physician practices serving patients using a payor-agnostic approach, by which Blue Shield aims to increase access to social services and community resources, improve health outcomes, reduce medical costs, and improve overall patient experience. The purpose of this case study is to understand the provider's perspective of embedding a CHA into the care team and the resulting impact on the practice and patients. Blue Shield also sought to identify best practices and barriers of a CHA program within primary and specialty care practices. As part of an ongoing two-year mixed-methods impact evaluation (2019–2021), 10 semi-structured interviews were conducted with a total of 18 providers and office staff at five primary care and specialty practices where CHAs have been embedded. We also conducted two focus groups with the same five CHAs at different points in time. Several themes emerged from the provider, office staff, and CHA interviews. Provider practices found great value in adding a CHA to their care team as the CHA brings flexibility and continuity to patient care. They also found that having access to a CHA with shared life experiences of the communities they served is a key component to the program's success. Providers and staff reported a new understanding of the social determinants of health that impacts a patient's wellbeing with the embedding of a CHA in the care team. Overall, practitioners expressed high satisfaction with the CHA program. During the COVID-19 pandemic, CHAs have been critically important in care, as social needs have increased, and resources have shifted. The CHA program is constantly adapting to address challenges faced by all stakeholders and applying new knowledge to ensure best practices are implemented within the CHA program.

Scoping Review on Menstrual Suppression Among U.S. Military Service Members

ABSTRACT Introduction The purpose of this scoping review was to systematically evaluate literature addressing menstrual suppression in the military population and to identify gaps in the literature. Materials and Methods A scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines was completed. Quality appraisal was conducted using the Johns Hopkins Evidence-Based Practice (EBP) Evidence Level and Quality Guide. Results Thirteen research articles and nine non-research articles were included. The themes identified were methods for menstrual suppression, barriers to menstrual suppression, and educational recommendations. Conclusions Six gaps were identified: (1) readiness, (2) single branch of service, (3) options for suppression, (4) hesitance to suppress, (5) provider practices, and (6) stagnant research. Recommendations for future research, practice, and military health policy are provided. Expanding research on menstrual suppression in U.S. military service members will enhance the health of military service members, provider practices, and military health policy to promote military readiness.