Update: Providing Quality Family Planning Services — Recommendations from CDC and the U.S. Office of Population Affairs, 2015

Weekly / March 11, 2016 / 65(9);231–234

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Loretta Gavin, PhD1; Karen Pazol, PhD2 (View author affiliations)

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In 2014, CDC published Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP), which describes the scope of services that should be offered in a family planning visit, and how to provide those services (e.g., periodicity of screening, which persons are considered to be at risk, etc.). The sections in QFP include Contraceptive Services, Pregnancy Testing and Counseling, Clients Who Want to Become Pregnant, Basic Infertility Services, Preconception Health Services, Sexually Transmitted Disease Services, Related Preventive Health Services, and Screening Services for Which Evidence Does Not Support Screening.

CDC and the Office of Population Affairs (OPA) developed QFP recommendations by conducting an extensive review of published evidence, seeking expert opinion, and synthesizing existing clinical recommendations from CDC, agencies such as the U.S. Preventive Services Task Force (USPSTF), and professional medical associations such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

The scope of preventive services related to reproductive health is constantly evolving as new scientific findings are published, and clinical recommendations are modified accordingly. Being knowledgeable about the most current recommendations is an important step toward providing the highest quality care to patients.

This report summarizes updated recommendations released from the time QFP was issued in April 2014 through the end of 2015. Recommendations are based on newly published findings or revisions in recommended best practices. Updates that have implications for clinical practice are highlighted (Box). In addition, an updated reference list is provided for guidelines published in 2014 and 2015 that did not result in any change in recommended practices for family planning providers.

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Corresponding author: Loretta Gavin, [email protected], 240-453-2826.

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1Office of Population Affairs, U.S. Department of Health and Human Services, Rockville, Maryland; 2Division of Reproductive Health, CDC.

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References

Updated Reference List, QFP Section

  1. Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the US Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-04).

Contraceptive Services

  1. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Committee Opinion No. 642; October 2015. http://www.acog.org/-/media/Committee-Opinions/Committee-on-Gynecologic-Practice/co642.pdf?dmc=1
  3. Ott MA, Sucato GS; Committee on Adolescence. Contraception for adolescents. Pediatrics 2014;134:e1257–81. CrossRef PubMed

Pregnancy Testing and Counseling

  1. American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 7th ed. Washington, DC: American Academy of Pediatrics and the American College of Obstetricians and Gynecologists; 2012.
  3. American College of Obstetricians and Gynecologists. Guidelines for women’s health care: a resource manual, 4th ed. Washington, DC: American College of Obstetricians and Gynecologists; 2014.

Clients Who Want to Become Pregnant

  1. Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril 2013;100:631–7. CrossRef PubMed

Basic Infertility Services

  1. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2015;103:e44–50. CrossRef PubMed

Preconception Health Services

  1. Kim DK, Bridges CB, Harriman KH; Advisory Committee on Immunization Practices (ACIP). Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older—United States, 2015. MMWR Morb Mortal Wkly Rep 2015;64:91–2. PubMed
  3. Strikas RA; Advisory Committee on Immunization Practices (ACIP). Advisory committee on immunization practices recommended immunization schedules for persons aged 0 through 18 years—United States, 2015. MMWR Morb Mortal Wkly Rep 2015;64:93–4. PubMed
  5. US Preventive Services Task Force. Drug use, illicit: primary care interventions for children and adolescents. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/drug-use-illicit-primary-care-interventions-for-children-and-adolescents
  7. US Preventive Services Task Force. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions
  9. US Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes
  11. US Preventive Services Task Force. Screening for high blood pressure in adults. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/high-blood-pressure-in-adults-screening

Sexually Transmitted Disease Services

  1. CDC; Health Resources and Services Administration; National Institutes of Health. Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014. Atlanta, GA: CDC; 2014. http://stacks.cdc.gov/view/cdc/26062
  3. Markowitz LE, Dunne EF, Saraiya M, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2014;63(No. RR-05). PubMed
  5. US Preventive Services Task Force. Behavioral counseling interventions to prevent sexually transmitted infections. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/sexually-transmitted-infections-behavioral-counseling1
  7. US Preventive Services Task Force. Screening for chlamydia and gonorrhea. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening
  9. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-03). PubMed

Screening Services for Which Evidence Does Not Support Screening

  1. US Preventive Services Task Force. Screening for chlamydia and gonorrhea. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening
  3. US Preventive Services Task Force. Screening for hepatitis B infection in nonpregnant adolescents and adults. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014

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Return to your place in the textBox. Updated Recommendations That Might Have Implications for Clinical Practice, by Section Heading — Providing Quality Family Planning Services: Recommendations from CDC and the U.S. Office of Population Affairs (QPF), 2015

Preconception Health Services

Blood pressure

  • The 2015 U.S. Preventive Services Task Force (USPSTF) recommendation reaffirms the 2007 recommendation to screen routinely for high blood pressure in adults (grade A*).

  • The 2015 statement explains how to perform office blood pressure measurement and emphasizes the need to confirm a diagnosis of hypertension outside of the clinical setting. The 2015 statement recommends optimal screening intervals for diagnosing hypertension in adults, such as annual screening for persons at increased risk (i.e., African American, high normal blood pressure, obese or overweight, aged >40 years) and every 3–5 years in persons at low risk (adults aged 18–39 years with no risk factors).

Source: USPSTF. Screening for high blood pressure in adults. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/high-blood-pressure-in-adults-screening.

Diabetes

  • The 2008 USPSTF statement recommended screening for diabetes in asymptomatic adults with hypertension (defined as sustained blood pressure of >135/80mm Hg).

  • The 2015 updated statement recommends screening for diabetes in adults aged 40–70 years who are overweight or obese, and referring patients with abnormal glucose levels to intensive behavioral counseling interventions to promote a healthful diet and physical activity (grade B†).

Source: USPSTF. Screening for abnormal blood glucose and type 2 diabetes mellitus. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes.

* A USPSTF grade A recommendation indicates there is high certainty that the net benefit is substantial. http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions.

† A USPSTF grade B recommendation indicates there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions.

Sexually Transmitted Disease (STD) Services

STD Treatment

  • The 2015 CDC STD treatment guidelines changed the age for screening sexually active young females for chlamydia from =25 years to <25 years. CDC and USPSTF recommendations are now aligned with regard to this age cutoff.

  • Persons with HIV infection should be tested at least annually for hepatitis C.

  • Transgender clients should be assessed for their STD- and HIV-related risks on the basis of current anatomy and sexual behaviors.

  • There are alternative treatment options for several STDs, including gonorrhea and genital warts.

Source: Workowski KA, Bolan GA, CDC. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-03).

Human Immunodeficiency Virus (HIV) Prevention for adults and adolescents with HIV

  • The new CDC guidelines provide additional information about how to care for patients with HIV, which go beyond the level of care provided by most family planning service providers in primary care settings.

  • The guidelines do not suggest any change from the original QFP recommendations with regard to screening for HIV.

  • Family planning providers should be aware of these guidelines because they might help inform the referrals that they provide for HIV-positive clients.

Source: CDC, Health Resources and Services Administration; National Institutes of Health. Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014. Atlanta, GA: CDC; 2014. http://stacks.cdc.gov/view/cdc/26062.

Screening Services for Which Evidence Does Not Support Screening

Gonorrhea

  • The previous USPSTF recommendation (2005) for gonorrhea recommended against routine screening for gonorrhea infection in men and women who are at low risk of infection (grade D§).

  • The revised recommendation (2014) notes that evidence is insufficient (grade I) for screening for chlamydia and gonorrhea among men.

  • Given this change in recommendations, gonorrhea screening for men is no longer a list of services for which evidence does not support screening, as was noted in Appendix F of QFP. However, because QFP recommends following CDC’s STD Treatment Guidelines 2015, which recommend screening of males at risk, no change for practice is suggested.

Source: USPSTF. Screening for chlamydia and gonorrhea. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening.

§ A USPSTF grade D recommendation indicates moderate or high certainty exists that the services have no net benefit or that the harms outweigh the benefits. http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions.

A USPSTF grade I recommendation indicates that the current evidence is insufficient to assess the balance of benefits and harms of the service (i.e., evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined). http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions.

Hepatitis B

  • The previous USPSTF recommendation (2004) recommended against screening for chronic hepatitis B virus (HBV) infection in asymptomatic persons in the general population (grade D).

  • The new recommendation (2014) advises screening among high risk populations, which include persons from countries with a high prevalence of HBV infection, HIV-positive persons, injection drug users, household contacts of persons with HBV infection, and men who have sex with men (grade B).

  • Although USPSTF did not reaffirm the grade D recommendation for the general population, it made this comment: “The prevalence of HBV infection is low in the general U.S. population and most infected persons do not develop complications. Therefore, screening is not recommended in those who are not at increased risk.” Hence, the revised HBV screening recommendations do not suggest any change from the original QFP recommendation for populations at low risk.

Source: USPSTF. Screening for hepatitis B infection in nonpregnant adolescents and adults. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014.

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Suggested citation for this article: Gavin L, Pazol K. Update: Providing Quality Family Planning Services — Recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep 2016;65:231–234. DOI: http://dx.doi.org/10.15585/mmwr.mm6509a3.

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