Adding contraception to the conversation
A hospitalist explains a recent call for her peers to consider their patients' family planning needs.
The U.S. Supreme Court's decision last month to reverse Roe v. Wade left many Americans wondering what they could do to help women avoid unintended pregnancies and maintain their reproductive health.
A recent Annals of Internal Medicine article offers an answer for hospitalists. “We argue that hospitalists should be addressing contraceptive needs among inpatients despite possible challenges,” wrote Eileen Barrett, MD, MPH, MACP, and Laura Chambers-Kersh, MD, in an Ideas and Opinions article, “Urgent Call to Action: Engaging Hospitalists in Family Planning,” published June 28.
ACP Hospitalist recently spoke with Dr. Barrett, who is a hospitalist based in Albuquerque, N.M., and Chair-elect of ACP's Board of Regents, about this potential new project for hospitalists.
Q: What would you like hospitalists to do with regard to family planning?
A: I would like to see hospitalists extend the way we think of our care, just as we've done to the care of patients with substance use disorders, to asking about and offering contraceptive services when desired. And I think that we're up for it.
Q: How would you recommend integrating this into hospitalist practice?
A: It can be customized to the physician, also the practice, and, of course, the patient. From the perspective of the patient, a lot of patients when they're first admitted are really sick, and so that may not be the time they wish to talk about it. Other times you quickly establish rapport, and then it's a very natural thing to ask about family planning—the same way that we ask about so many other deeply personal things in patients' lives and seek to address them.
I have done this as a hospitalist for about ten years. During an admission I'll either ask about family planning or I'll write it in my note to address it in the morning and do so then. In some cases, it has also come up on the day of discharge. I consider addressing it at all points of the hospitalization when the patient is well enough to discuss it.
Q: Your commentary mentions that family planning isn't a part of many hospitalists' training. What will hospitalists need to learn in order to do this?
A: It's important to know this is something that we can do and that we've always added new learning into our practice, such as with COVID, novel antimicrobials, or new oral anticoagulants. It's also important to know that it's OK if we don't have all the answers, and that we're not alone. The CDC has medical eligibility criteria [for contraceptive use]. It is available via an app and it is also available on their website. Oftentimes, the patients know a lot about family planning methods, and what they want and what has worked for them before and they would like to restart. If that's not the case, it's very easy for hospitalists to ask about and offer Depo [medroxyprogesterone acetate] shots. There are very few medical contraindications to giving it; we can easily give it before discharge and then arrange follow-up in clinic.
If we're unsure what to do, we can always talk with a team pharmacist or consult with our OB/GYN colleagues. I've never heard of a gynecologist who didn't want to help a patient who desires family planning to get it! They are really a wonderful resource for us.
Q: What would you say to concerns, from hospitalists or their employers, that this will take up time needed for other kinds of care?
A: In my experience, when it isn't addressed, it isn't because we don't have time—it's because it isn't something that we realized was an issue. And I don't fault anybody for that. Most of us practicing hospital medicine were trained in internal medicine, and our training didn't include a lot of family planning, because usually the patients were older. Asking about and ordering contraception is generally very brief, and no more time-consuming than asking about their postdischarge plans. We should keep in mind we don't have to have all of the answers in one interaction with the patient because we can readdress any questions in subsequent days of their admission.
Q: What other steps could hospitals take to address family planning?
A: Hospitalists can also ask about and provide emergency contraception at discharge, and also ask discharge planners to provide follow-up appointments at Planned Parenthood or public health clinics if there are concerns that patients can't get contraception in their primary care clinic. We can also suggest this topic for grand rounds, journal clubs, and other educational events.
Q: Any other advice for hospitalists on this issue?
A: Many are feeling overwhelmed and feel powerless because of national dialogue on family planning and the recent [Supreme Court] decision. In times like this the most important thing is to just start with what we can do for the person who is in front of us. And in this case, that is to ask about and offer family planning where it's wanted.