Provision of early pregnancy loss care in New York federally qualified health centers

Abstract

Background: Office-based early pregnancy loss (EPL) care is safe and suitable to Federally Qualified Health Centers (FQHCs); prevalence of provision in FQHCs is unknown. Methods: We conducted a mailed site-level survey of FQHCs in New York State (n = 405). Sites that offered prenatal care were eligible for analysis. Questions included provision of and barriers to providing EPL care options. Content analysis was used for write-in responses to barriers. We conducted bivariate analyses using Fisher's Exact tests and risk ratios to investigate associations between EPL care provision and the independent variables site urbanicity, prenatal clinician type, and ultrasound access. Results: Of 181 mailings returned, 63 sites were eligible (response rate 44.7%); 88.9% provided expectant management, 53.9% medication management, and 23.8% uterine aspiration. Common barriers included lack of clinical infrastructure, poor ultrasound access, and insufficient training. Some held perceived barriers regarding uterine aspiration. Sites with regular ultrasound access were 1.85 times as likely to provide uterine aspiration as sites without regular ultrasound access (95% CI, 1.16-2.95). Conclusions: Few New York FQHCs provided comprehensive EPL care. Supporting FQHCs to overcome barriers may expand access to EPL treatment in primary care and increase continuity and patient centeredness.