Name
#22 - Building a More Prepared Walk-In Contraceptive Services (WiCS) Implementation Through Pre-Implementation Assessment
Date & Time
Monday, February 12, 2024, 12:00 PM - 7:00 PM
Description

Introduction. During October 2022, the Defense Health Agency (DHA) launched a walk-in contraception services (WiCS) initiative in accordance with DHA-AI 6025.09. It supported wide implementation across the Military Health System, as a direct care service primarily for active duty service members (ADSMs) by January 30, 2023. In general, WiCS provides same-day, no appointment, and non-referred wide-scope contraception services, including short-acting reversible contraception (SARC) prescribing, long-acting reversible contraception (LARC) procedures, emergency contraception (EC), and education on menstrual suppression, barrier contraception, and natural family planning (NFP). DHA’s Women’s Health Clinical Management Team (WHCMT) and Research and Engineering (R&E) Implementation Science Branch (ISB) partnered to plan and execute this implementation. This presentation shares analysis, interpretations, and recommendations from a formal pre-implementation assessment administered to support the program’s implementation planning. Methods. By request from DHA Medical Affairs (MA), WHCMT administered a data call directed to all DHA Markets during November 2022. This data call sought military medical treatment facilities’ (MTF) pre-implementation status of contraceptive services, helping to inform on strategy for eventual and official WiCS implementation. All MTFs with known contraceptive services provision since 2019 received the data call. Among the 147 total parent Defense Medical Information System Identifier (DMIS ID) footprint of MTFs initially identified, 94 (64%) eventually responded. Mostly unstructured and qualitative in collection, data was reviewed and processed into a more structured and readily analyzable dataset. Results. Among 147 total parent footprints, 42 (29%) self-reported existing WiCS, despite lacking prior disseminations of standard criteria of what WiCS entails. Another 41 (28%) reported in-progress status. Eleven (8%) reported non-initiated status. The remaining 53 (36%) failed to respond. Among the total 94 responding parent footprints, 11 staff members, on average, were recorded to be LARC credentialed. It appears more were recorded for those in large markets, as compared to small and standalone markets. As for LARC credentialing need, 51% recorded need – on average, 5.4 staff members. Need was most often recorded for those in small markets. Ten parent footprints (11%) intimated a desire for program exemption in volunteered feedback. A scan of volunteered feedback also revealed 46 (49%) sharing potential barriers to program implementation. Staffing needs were the most frequent barrier type volunteered. Staffing needs were most often volunteered within small and standalone markets. Other frequent barrier types volunteered included challenging cultural inertia assuming that standard appointing practices are necessary for contraceptive services and staff education and training needs. The most frequent feedback on addressing potential challenges to WiCS implementation was rotating relevant staff across practices and facilities to meet staffing needs. Conclusions. This pre-implementation assessment was valuable in gaining a sense of scope necessary to implement WiCS MHS-wide and considering remediations to potential challenges during the planning and execution process. Remediations applied were varied, including actions to address WiCS requirements dissemination, resource and staff sharing, and LARC training and privileging. By January 2023, all parent DMIS footprints targeted for WiCS stand-up reported availability of weekly services with designated providers and availability of both SARCs and LARCs.

Location Name
Prince Georges Exhibit Hall A/B
Content Presented on Behalf of
DHA
Learning Outcomes
1. Describe WiCS as a program that implemented standard contraceptive services across the MHS.
2. Summarize pre-implementation assessment meant to help inform on implementation strategy.
3. Share actions considered and executed to remediate potential challenges observed from the pre-implementation assessment.
Session Type
Posters
Dropdown Content Presented On Behalf Of:
DHA