title: A checklist approach to caring for women seeking pregnancy testing: effects on contraceptive knowledge and use.
abstract: OBJECTIVE
  To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing.
  
  
  METHODS
  Pre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models.
  
  
  RESULTS
  Between January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, [aOR 4.66 (1.76-12.35)], [corrected] have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, p<0.001). Three months after visiting the study clinic, participants from the intervention period were more knowledgeable about intrauterine and subdermal contraception and were more likely to report at 3-month follow-up a method of contraception more effective than the method they used prior to seeking pregnancy testing from the study clinic (aOR=2.02, 95% CI=1.03-3.96). The authors would like to apologize for any inconvenience caused. [corrected].
  
  
  CONCLUSIONS
  Women seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in the 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling.
  
  
  CONCLUSIONS
  A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of more effective contraception.
authors.affiliation: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lee
authors.affiliation: University of Pittsburgh, Department of Medicine.
authors.forename: Melissa
authors.initials: M
authors.lastname: Papic
authors.affiliation: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences; University of Pittsburgh, Department of Medicine.
authors.forename: Erin
authors.initials: E
authors.lastname: Baldauf
authors.affiliation: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences.
authors.forename: Glenn
authors.initials: G
authors.lastname: Updike
authors.affiliation: University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences; University of Pittsburgh, Department of Medicine; University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology. Electronic address: ebschwarz@ucdavis.edu.
authors.forename: E Bimla
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D057189:Checklist; D003267:Contraception; D003268:Contraception Behavior; D044363:Contraception, Postcoital; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004343:Drug Implants; D005193:Family Planning Services; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007434:Intrauterine Devices; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010414:Pennsylvania; D011258:Pregnancy Tests; D058996:Quality Improvement; D012736:Sex Education; D019037:Urban Health Services; D000078329:Workforce; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants
keywords: Intrauterine Contraception; Pregnancy testing; checklist; contraceptive counseling; emergency contraception