Impact of a Multifaceted Educational Program to Improve Provider Skills for Lupus Pregnancy Planning and Management: A Mixed-Methods Approach.
Repository Usage Stats
OBJECTIVE:To bring recent advances in pregnancy management in lupus to women nationwide, this multidimensional educational intervention sought to equip community rheumatologists with the needed skills, attitudes, and confidence to manage contraceptive decisions and pregnancy planning for women with lupus. METHODS:The program included an in-person didactic, training in use of a comprehensive handout to guide contraception and pregnancy conversations, a simulated clinical experience, and access to an innovative website (www.lupuspregnancy.org). The program was analyzed using mixed methods, which included a quantitative survey by e-mail before and after program completion and multiple qualitative interviews about attendees' experiences integrating created resources into practice. RESULTS:The analysis included 68 preintervention surveys and 55 postintervention surveys. For qualitative analysis, eight interviews were completed until thematic saturation was achieved. After completion of the program, there was an increase in providers reporting a systematic approach to preparing a woman with lupus for pregnancy (from 45.6% to 94.6%; P < 0.0001). Confidence in choosing both appropriate contraception and pregnancy-compatible medications improved significantly. As expected, change in knowledge about contraception was limited. Qualitative themes included the utility of the printable handouts, enthusiasm for the program, increased confidence and, importantly, increased empathy for the patients. CONCLUSION:We created a valuable implementation tool that improves self-reported provider skills and confidence in managing women with lupus who desire pregnancy. Providers now have access to a unique curriculum and resources that encourage providers to have open and accurate conversations about pregnancy, thus creating lasting clinical change.
Published Version (Please cite this version)
Njagu, Ravyn, Lisa G Criscione-Schreiber, Amanda Eudy, Amanda Snyderman and Megan EB Clowse (2020). Impact of a Multifaceted Educational Program to Improve Provider Skills for Lupus Pregnancy Planning and Management: A Mixed-Methods Approach. ACR open rheumatology, 2(6). pp. 378–387. 10.1002/acr2.11147 Retrieved from https://hdl.handle.net/10161/26172.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
My clinical interests include systemic lupus erythematosus (SLE) and inflammatory myopathies, specifically dermatomyositis, polymyositis, and the anti-synthetase syndrome. Additionally, I maintain a general rheumatology continuity clinic for individuals with rheumatoid arthritis, vasculitis, and other forms of inflammatory arthritis and autoimmune diseases. In 2007, I co-founded the Duke Lupus Clinic with Dr. Megan Clowse. We have continued this clinic with the aim to improve the health and quality of life for individuals living with lupus.
My primary research interests are in education and in SLE. My particular interest within education is learner assessment. I was previously funded by a Clinician Scholar Educator Award through the Rheumatology Research Foundation of the American College of Rheumatology. My CSE project explored validation of a rheumatology objective structured clinical examination (ROSCE). I previously participated on the ACR/NBME rheumatology in-training examination working group for 3 years. I work closely with my Rheumatology Program Director collaborators at UNC Chapel Hill, Wake Forest University and the Medical University of South Carolina through our Carolinas Fellows Collaborative. Members of this group composed the competency-based goals and objectives (CBGO) for all learning activities of rheumatology fellowship training programs, which were adopted by the American College of Rheumatology and are posted on their website. I currently Chair the ACR Curriculum Subcommittee of the Committee on Training and Workforce.
My research in lupus has included the Duke Lupus Registry population. Our recent work focuses on creating and defining the type 1 and type 2 lupus paradigms for classifying lupus disease activity. Additional interests through the Duke Lupus Clinic include elucidating clinician-level factors that can influence medication adherence as well as determining how health literacy and numeracy impact adherence and patient level outcomes. Additionally, I have collaborated closely with Dr. Megan Clowse, who studies reproductive health in women with autoimmune diseases, for many years. We have combined her subject matter expertise with my educational skills to create HOP-STEP, a program to teach patients with lupus and their rheumatologists about pregnancy planning to improve health outcomes. We have created lupuspregnancy.org, which houses many resources and videos designed to teach rheumatologists to better partner with women with lupus to have open and honest discussions about pregnancy planning. Our ultimate aim is to improve the health outcomes for women with lupus and their offspring.
Dr. Megan Clowse is an Associate Professor of Medicine in the Division of Rheumatology and Immunology. Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 600 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and now the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository. She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020. Dr. Clowse created www.LupusPregnancy.org, a website dedicated to improving lupus pregnancy planning and management for patients and rheumatologists.
Dr. Clowse was the founding director of the Duke Lupus Clinic, where she continues to see patients each week and mentor junior faculty researchers. The team has developed a new approach to lupus classification and management and is currently collecting and analyzing patient- and physician-reported measures to better clarify this construct.
As the Co-Director of Duke Forge, Dr. Clowse has shepherding multiple Department of Medicine-funded studies to identify and build innovative approaches to using health data to improve patient care.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.