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Gregory M. Gressel MD PGY-2

Patient and provider perspectives on Bedsider.org in a low income, racially diverse clinic population. Gregory M. Gressel MD PGY-2. Department of Obstetrics, Gynecology and Reproductive Sciences. Disclosure.

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Gregory M. Gressel MD PGY-2

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  1. Patient and provider perspectives on Bedsider.org in a low income, racially diverse clinic population Gregory M. Gressel MD PGY-2 Department of Obstetrics, Gynecology and Reproductive Sciences

  2. Disclosure • This speaker has no conflicts of interest to disclose relative to the contents of this presentation.

  3. Objectives At the end of this presentation, participants should be able to: • Discuss the opinion of 18-29 year old women in a low-income, racially-diverse clinic population of Bedsider.org. • Discuss the viewpoint of physicians, midwives, nurse practitioners and support staff exposed to Bedsider.org. • Describe the efficacy of Bedsider.org in improving patient contraceptive knowledge and intention to use long-acting reversible contraception (LARC) methods.

  4. Yale New Haven Hospital Women’s Center • 19,000 visits annually • 60% Medicaid, 40% free care • 45% Hispanic, 37% black, 13% white, 1% asian, 4% “other”

  5. Study Aims and Objectives: • Aim 1: To expose 18-29 year old women in a low-income, racially diverse clinic population to Bedsider • Aim 2: To expose clinic physicians, midwives, nurse practitioners and support staff to Bedsider • Aim 3: To assess patient contraceptive knowledge and birth control intention before and after exposure to Bedsider

  6. Methodology • Mixed methods study • Focus groups • Patients • Clinicians and clinic staff • Yale New Haven Hospital’s Women’s Center • Urban, Medicaid-based clinic • Cares for an at-risk population of diverse, young women. • Patients completed surveys • To assess contraceptive knowledge and intention • Before and after exposure to Bedsider

  7. Eligibility Criteria • Patient Participants • 18-29 years of age • Seeking contraception, heterosexually active • Not planning new pregnancy in next 12 months • Could be pregnant at time of focus group • English or Spanish speaking • LARC naive • Women without a history of sterilization or hysterectomy • Provider Participants • MDs, midwives, NPs, nurses, medical assistants, office staff

  8. Participant Enrollment

  9. Patient Demographics

  10. Intention to use birth control methods

  11. Assessment of pre-vs. post- exposure knowledge of birth control efficacy

  12. Quotes on Accessibility Patients: “Everything was perfect. Everything was in order, very easy to use. I thought it was going to be difficult ... I mean, for people like us, it’s awesome. Other people don’t really know how to use computers… Yeah navigating was perfect.” Providers: “It’s just a ton of information just feels like where do we go next. It’s just a lot. So a lot of our population may not have desktop or laptop they may have it just on phones, so it may be harder to navigate where they’re going. If it was a little bit cleaner.” “It needs to be simpler for our patients”

  13. Quotes on Empowerment • Patients: • “I didn’t know a lot about all the different types of birth control…now I know that there (are) many different varieties I can choose from.” • “It opened me to a couple of methods of birth control that I wouldn’t have considered using before.” • Providers: • “I feel like, that’s like, it’s almost like smutty.” • “I think it is borderline pornographic.” • “The fact is we’re trying to empower women to use this, and I feel that its sending the wrong message that um it’s ok to be trashy”

  14. Quotes on Legitimacy • Patients: • “They had actual women who had IUDs and the Mirena and they were talking about it so I thought it was really good.” • “The videos helped a lot. Where you could hear somebody talk about it instead of just reading it.” • Providers: • “There’s some concerning information that I don’t think is accurate or should be promoted to young patients.” • “But I think if they’re going to get their information online, this is definitely better than some of the information that is floating out around there. And as far as medical facts go, it’s not quite as accurate as what I’m telling my patients, but it's certainly closer than a lot of information out there on some seemingly formal-looking websites.”

  15. Strengths & Limitations • Strengths • New insights • Thematic saturation • Limitations • Did not meet our enrollment goals • Unable to interview Spanish speaking patients

  16. Conclusions • Patients like Bedsider • Even in a low-income patient population with limited resources, patients find Bedsider accessible, easy to use and informative. • Translating Bedsider into other languages and marketing it more broadly may make it available to a wider audience. • Bedsidermay improve knowledge about birth control options and increase intention to use more effective contraceptive methods. • We, as providers, may be out of touch with our patient population and may need to re-think how to approach contraceptive education.

  17. Special Thanks: • Aileen Gariepy MD, MPH • LisbetLundsberg PhD • Jessica Illuzzi MD • Cheryl Danton RN

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