• Michigan Quality Improvement Consortium. Prevention of unintended pregnancy in adults 18 years and older. Southfield (MI): Michigan Quality Improvement Consortium; 2007 Jun. 1 p.

This is the current release of the guideline.

Unintended pregnancy

Counseling
Evaluation
Prevention
Risk Assessment

Family Practice
Internal Medicine
Obstetrics and Gynecology
Preventive Medicine

Advanced Practice Nurses
Health Plans
Physician Assistants
Physicians

• To achieve significant, measurable improvements in the prevention of unintended pregnancy through the development and implementation of common evidence-based clinical practice guidelines
• To design concise guidelines that are focused on key management components of prevention of unintended pregnancy to improve outcomes

Males and females 18 years and older

Evaluation/Risk Assessment

1. Assessing for risk of unintended pregnancy by asking about sexual activity, past pregnancy, abuse, use of birth control or protection, and intention to become pregnant or father a child

Counseling/Prevention

1. Counseling patients regarding risk of pregnancy and adverse outcomes associated with unintended pregnancies
2. Discussing contraceptive methods and offering prescriptions
3. Encouraging latex condom use
4. Referring to primary care provider, local health department, family planning clinic, or hotline
5. Follow-up

Not stated

Searches of Electronic Databases

The Michigan Quality Improvement Consortium (MQIC) project leader conducts a search of current literature in support of the guideline topic. Computer database searches are used to identify published studies, existing protocols and/or national guidelines on the selected topic developed by organizations such as the American Diabetes Association, American Heart Association, American Academy of Pediatrics, etc. If available, clinical practice guidelines from participating MQIC health plans and Michigan health systems are also used to develop a framework for the new guideline. 

Not Stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

Review

Not stated

Expert Consensus

Using information obtained from literature searches and available health plan guidelines on the designated topic, the Michigan Quality Improvement Consortium (MQIC) project leader prepares a draft guideline to be reviewed by the medical directors' committee at one of their scheduled meetings. Priority is given to recommendations with [A] and [B] levels of evidence (see "Rating Scheme for the Strength of the Evidence" field).

The initial draft guideline is reviewed, evaluated, and revised by the committee resulting in draft two of the guideline. Additionally, the Michigan Academy of Family Physicians participates in guideline development at the onset of the process and throughout the guideline development procedure. The MQIC guideline feedback form and draft two of the guideline are distributed to the medical directors, as well as the MQIC measurement and implementation group members, for review and comments. Feedback from members is collected by the MQIC project leader and prepared for review by the medical directors' committee at their next scheduled meeting. The review, evaluation, and revision process with several iterations of the guideline may be repeated over several meetings before consensus is reached on a final draft guideline.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

When consensus is reached on the final draft guideline, the medical directors approve the guideline for external distribution to practitioners with review and comments requested via the Michigan Quality Improvement Consortium (MQIC) health plans (project leader distributes final draft to medical directors' committee, measurement and implementation groups to solicit feedback).

The MQIC project leader also forwards the approved guideline draft to appropriate state medical specialty societies for their input.  After all feedback is received from external reviews, it is presented for discussion at the next scheduled committee meeting. Based on feedback, subsequent guideline review, evaluation, and revision may be required prior to final guideline approval.

The MQIC Medical Directors approved this guideline in June 2007.

The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

Assessment for Risk of Unintended Pregnancy

Ask about:

• Sexual activity/involvement, past pregnancy and outcome
• Abuse (e.g., Were you pressured or forced to have sex when you did not want to?)
• Consistent use of birth control or protection (e.g., Does it ever happen that you have sex without using birth control or protection?)
  • If contraception is used, assess type
• Intent to become pregnant or father a child (e.g., Are you trying to get pregnant? Are you trying to father a child?)

If currently pregnant discuss postpartum contraception.

Frequency

At annual health exam; more frequently at the discretion of the health care provider [D]

Intervention to Prevent Unintended Pregnancies

Advise and discuss:

• Patient's risk of pregnancy or contributing to an unintended pregnancy
• Risks and adverse outcomes associated with unintended pregnancies

Assess:

• Patient's understanding of risks and readiness to make behavior changes

Assist patients in preventing unintended pregnancy by:

• Discussing all contraceptive methods [B]
• Offering prescriptions
• Encouraging consistent latex condom use for sexually transmitted infection prevention [B]
• Referring to primary care provider, local health department, family planning clinic, Plan First, federally qualified health center or hotline

Arrange follow-up

Frequency

At annual health exam; more frequently at the discretion of the health care provider [D]

Definitions:

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

None provided

Through a collaborative approach to developing and implementing common clinical practice guidelines and performance measures for prevention of unintended pregnancy in adults 18 years and older, Michigan health plans will achieve consistent delivery of evidence-based services and better health outcomes. This approach also will augment the practice environment for physicians by reducing the administrative burdens imposed by compliance with diverse health plan guidelines and associated requirements.

Not stated

This guideline lists core management steps. Individual patient considerations and advances in medical science may supersede or modify these recommendations.

Staying Healthy

Effectiveness
Patient-centeredness

• Michigan Quality Improvement Consortium. Prevention of unintended pregnancy in adults 18 years and older. Southfield (MI): Michigan Quality Improvement Consortium; 2007 Jun. 1 p.

2007 Jun

Michigan Quality Improvement Consortium - Professional Association

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Director's Committee

Physician representatives from participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health and Michigan Peer Review Organization

Standard disclosure is requested from all individuals participating in the Michigan Quality Improvement Consortium (MQIC) guideline development process, including those parties who are solicited for guideline feedback (e.g. health plans, medical specialty societies). Additionally, members of the MQIC Medical Directors' Committee are asked to disclose all commercial relationships.

This is the current release of the guideline.

This NGC summary was completed by ECRI Institute on March 5, 2008. The information was verified by the guideline developer on March 12, 2008.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.