Background/Purpose: Among women with systemic rheumatic diseases (SRD), poor maternal and fetal outcomes may occur if disease activity and medication use are not optimized preconception. We conducted a needs assessment of rheumatologists’ potentially modifiable practices around fertility intention screening and contraceptive prescribing. We then implemented an intervention to ameliorate noted gaps in care.

Methods: Using the electronic medical record (EMR) at a large academic medical center, we identified women 18-50 years with SRD and assessed teratogenic medication use, contraceptive use, and obstetrics and gynecology (OB/GYN) care during the year prior to our intervention. We administered a 13-item survey to the rheumatologists to assess fertility intention screening and contraceptive prescribing. We then introduced our intervention, the validated One Key Question^® (OKQ), “Would you like to become pregnant in the next year?” to rheumatologists during a rheumatology-OB/GYN Grand Rounds lecture, created an EMR template for OKQ documentation, flagged potentially eligible SRD patients each week in the EMR, and introduced a streamlined referral system to facilitate access to OB/GYN care.

Results: We identified 625 women 18-50 with SRD seen by a rheumatologist ≤1 year prior to OKQ implementation. Of these, 66% received ≥1 medication with known teratogenic risk. Thirty-three percent of these women had any documented contraception and 5% had been referred to OB/GYN in the previous year. We received survey responses from 74% (32/43) of the practicing rheumatologists. While many providers frequently discuss contraception when prescribing a teratogen, few utilize educational materials and almost none provide contraception (Figure). When asked about comfort assessing patients’ reproductive goals, 31% felt very comfortable, 50% somewhat comfortable, and 19% not very comfortable or unsure (Table). Providers cited multiple potentially modifiable barriers to screening, most notably lack of time (63%), lack of knowledge (31%) or not knowing where to refer patients (41%). Within 2 months of implementation, the OKQ has been documented in 58 charts by 11 providers, and 11 patients (19%) were referred to OB/GYN.

Conclusion: In this large, academic rheumatology practice, physician comfort with reproductive health was highly variable and referrals for OB/GYN care infrequent. Implementation of a single question fertility intention screen (OKQ) may help ensure that an assessment of patients’ family planning needs and appropriate follow-up are incorporated into their rheumatologic care.