Clinicians’ proffered solutions to enhancing SRH care in rheumatology.
| Solution Types | No. of Participants Who Endorsed the Solution With Verbal or Written (In Chat) Feedback |
|---|---|
| Pre-visit forms or clinic resources | |
| Patient forms should elicit information about current sexual activity, pregnancy planning, contraception use, and need for OB-GYN referral | 5 |
| Patient checklist for contraception use and pregnancy goals | 4 |
| Clinic posters, messages on television screens prompting patients to talk to their clinicians about SRH | 3 |
| SRH questionnaire provided to all new patients and twice a year for returning patients, with responses autopopulated into clinic note | 3 |
| EHR tools | |
| Alert to remind clinicians to review reproductive health during visit | 4 |
| Contraception checklist embedded into the EHR | 4 |
| Best practice alerts about medication compatibility with pregnancy and lactation | 4 |
| Alert if patient has had a tubal ligation, menopause, or hysterectomy so that family planning does not need to be discussed at the visit | 4 |
| Smartphrase for pregnant patients, with orders for relevant testing and handouts to add automatically to discharge paperwork | 3 |
| Reproductive history template that can be pulled into the clinic note | 3 |
| Alert if patient is of reproductive age | 3 |
| Alert if a patient is using a birth control method that is not compatible with their disease and risk factors (eg, patients with increased thrombosis risk) | 2 |
| Patient instructions about family planning integrated into discharge paperwork automatically | 2 |
| Alert if patient is of reproductive age and using a medication with potential teratogenicity | 1 |
| Referrals to reproductive and women’s health providers | |
| Referral system established with dedicated OB-GYN and MFM providers | 5 |
| Referral to a multidisciplinary team of OB-GYN or MFM clinicians and pharmacists | 5 |
| Automatic referral to high-risk obstetrics if pregnant patient has specific risk factors (Ro/La antibodies, antiphospholipid antibodies) | 3 |
| Patient referral to pharmacist who has familiarity with safety and efficacy of contraceptives and can advise selection of safe option | 3 |
| Automatic referral to OB-GYN if patient desires contraception | 2 |
| Automatic referral to OB-GYN is patient is of reproductive age, has gestational potential, using a potentially teratogenic medication, and is not using contraception | 2 |
| Dedicated visit with an APP or nurse to discuss pregnancy planning with follow-up visit coordinated with OB-GYN or MFM | 2 |
| Patient resources | |
| Brochures, pamphlets | 8 |
| Links provided to ACR SRH resources, Arthritis Foundation, Lupus Foundation, Lupus HOP-STEP program | 4 |
| Provide SRH resources through electronic patient portal | 1 |
| Provider resources | |
| Single website that combines evidence-based SRH resources | 7 |
| Quality metric added to rheumatology clinic standards | 2 |
| Guidelines for compatibility of radiology imaging modalities with pregnancy | 1 |
| Certification in SRH within rheumatology | 1 |
| Grand rounds and educational sessions provided by expert speakers | 1 |
ACR: American College of Rheumatology; APP: advanced practice provider; EHR: electronic health record; HOP-STEP: Healthy Outcomes in Pregnancy with SLE through Education of Providers; MFM: maternal fetal medicine; OB-GYN: obstetrician and gynecologist; SLE: systemic lupus erythematosus; SRH: sexual and reproductive health.