Background/Purpose: While centers have worked to optimize lupus pregnancy outcomes, additional efforts are required to have a broader impact on lupus pregnancy outcomes. The goal of this educational initiative was to create a multi-dimensional intervention to equip community rheumatologists with the needed skills, attitudes, and confidence to effectively manage contraceptive decisions and improve pregnancy outcomes.

Methods: Design of the HOP-STEP program included a needs assessment followed by development of a comprehensive program using mixed modalities to create lasting practice change. The program included an in-person didactic, a simulated clinical experience, training in use of a comprehensive handout to guide open contraception and pregnancy conversations, and access to a website with additional resources including certified medical education. We assessed program impact using a mixed methods approach.  A survey was emailed to 149 individuals before and after workshop completion. All attendees were invited to be interviewed about their experience integrating HOP-STEP resources into practice.

Results: We analyzed 68 pre-surveys (response rate 46%, 93% women, 66% attending-level rheumatologists) and 55 post-surveys (response rate 37%, 96% women, 64% attending-level rheumatologists). For qualitative analysis, 8 interviews were completed until thematic saturation was achieved.   At program completion, the percentage of providers reporting a systematic approach to preparing a woman with lupus for pregnancy increased from 45.6% to 94.6%; p< 0.0001. When assessed using confidence scale (0=no confidence, 100=high confidence), median provider confidence in helping women with lupus choose appropriate contraception increased from 59 to 89; p< 0.0001 and confidence in choosing pregnancy compatible medications increased from 66 to 91; p< 0.0001.   While participants demonstrated limited change in contraceptive knowledge, an emerging theme was use of the HOP-STEP contraception handout:   “I’m not really comfortable recommending birth control method[s], but it was interesting to see that whole [contraception] chart…it did increase my confidence because I could just cheat and look at it and show [patients] visually.”   After the program more providers correctly identified azathioprine (74% to 98%, p < 0.0001) and tacrolimus (46% to 91%, p < 0.0001) as pregnancy compatible and mycophenolate as teratogenic (84% to 96%, p=0.04). Regarding comparative teratogenicity, a common theme was elucidated by the following quote:   “That Cellcept is as high as it is on the list of drugs that are very bad for fetuses…I didn’t realize that quite as much as I should’ve, everybody knows about methotrexate, but the fact that Cellcept is probably even worse than methotrexate I was not aware of…”

Conclusion: We have demonstrated successful creation and delivery of a new multi-modal educational program, HOP-STEP, that has improved provider confidence, skills, and knowledge in managing women with lupus who desire pregnancy. Providers may now access a unique curriculum and resources that encourage providers and patients to have open and accurate conversations about pregnancy, creating lasting clinical change.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-the-healthy-outcomes-in-pregnancy-with-sle-through-education-of-providers-hop-step-program-a-mixed-methods-approach/