Assessing community health center practices in preconception care delivery

Background: Adverse perinatal outcomes can be reduced through preconception care (PCC). The CDC has published recommended guidelines on PCC, but compliance has not been studied. We assessed the degree of implementation of the PCC guidelines within Community Health Centers (CHCs) as well as the nature of implementation. Methods: To assess provider knowledge, range of PCC services and degree of community participation, we developed a pilot survey, based on the CDC recommended guidelines, and conducted it among clinical leaders of CHCs in the Boston metropolitan area. Areas of inquiry included adherence to evidence-based recommendations (e.g., folic acid supplementation, tracking and risk assessment systems). We defined adequate delivery of PCC as implementation of 80% of the recommendations. Results: The surveyed CHCs reported that: 50% used social media as a preconception health promotion tool, 50% actively identified high risk patients, 33% tracked high-risk patients, and 20% conducted focus groups about PCC with community members. None did community outreach about contraception or preconception health and none targeted family planning sessions to men. All listed language barriers, insufficient time, provider knowledge and lack of funding for specialized staff (e.g., interpreters) as challenges to successful delivery of PCC. None achieved the 80% benchmark of compliance with the CDC guidelines Conclusions: CHCs in a major metropolitan area had not fully implemented the CDC's recommended guidelines on PCC. We will focus our recommendations to reduce barriers on provider and staff education and restructuring of care delivery through the Patient-Centered Medical Home and other evolving models within primary care.