title: Systems Change Enhances Access to Family Planning Training and Care Delivery.
abstract: OBJECTIVE
  Long-acting reversible contraceptives (LARCs) are very effective methods of pregnancy prevention. To ensure autonomy over childbearing, women need access to contraception and abortion services. Family physicians can improve access by increasing numbers and locations of trained providers. In 2014, the University of Maryland (UMD) Reproductive Health EDucation In family medicine (RHEDI) program sought to enhance LARC and abortion training by increasing: (1) resident participation in LARC services, (2) resident participation/interest in abortion care, (3) patient access to LARCs and medication abortions (MABs).
  
  
  METHODS
  
  
  
  METHODS
  We used a pre-post framework comparing years 2013 and 2014 with respect to number of resident-provided LARC services, number of residents participating in abortion, and total number of LARCs and MABs provided practice-wide.
  
  
  METHODS
  The setting is an urban residency practice.
  
  
  METHODS
  (1) increased dedicated appointments for LARC and MABs, (2) dedicated appointment scheduler, (3) comprehensive family planning didactics and clinical workshops, (4) faculty-supported Residents for Choice group.
  
  
  RESULTS
  2014: Residents provided substantially more LARC services compared to 2013. Placement increased from 50 to 90, and removals tripled (25 to 73). 2014 site-wide LARC placement also increased (160 versus 98), removals increased (44 in 2013, 106 in 2014). Twelve residents per year are eligible to participate in abortion care. In 2013, two participated: in 2014, 10 participated. MABs provided in 2014 (18) did not change from 2013 (17).
  
  
  CONCLUSIONS
  The UMD RHEDI program demonstrated that attention to care-provision systems and education enhances resident training and increases patient access to family planning services. Programs with similar goals may find our methods helpful.
authors.affiliation: Department of Family and Community Medicine, University of Maryland.
authors.forename: Diana N
authors.initials: DN
authors.lastname: Carvajal
authors.forename: Niharika
authors.initials: N
authors.lastname: Khanna
authors.forename: Mozella
authors.initials: M
authors.lastname: Williams
authors.forename: Marji
authors.initials: M
authors.lastname: Gold
mesh_terms: D000028:Abortion, Induced / Q000193:education; D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004503:Education, Medical, Graduate; D005193:Family Planning Services / Q000379:methods*; D005194:Family Practice / Q000193:education; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D011247:Pregnancy; D034121:Reproductive Health Services / Q000458:organization & administration