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Implementing Preconception Health Care in Clinical Settings: A Case Study of Inter-Professional Discourse at an Academic Medical Center . Renaisa S. Anthony MD, MPH Deputy Director, Center for Reducing Health Disparities Assistant Professor, UNMC COPH (402) 559-5327

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Implementing Preconception Health Care in Clinical Settings:

  • A Case Study of Inter-Professional Discourse
  • at an Academic Medical Center

Renaisa S. Anthony MD, MPH

Deputy Director, Center for Reducing Health Disparities

Assistant Professor, UNMC COPH

(402) 559-5327

[email protected]

June 13, 2011

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DOUGLAS & SARPY COUNTY, NEBRASKA

  • Stark disparities in:
  • Preterm birth
  • Low Birth weight babies
  • Infant Mortality
  • Teen Pregnancy
  • STD Rates
  • Obesity
  • Chronic Illnesses (Hypertension)
  • ALL IMPACT REPRODUCTIVE AND PREGNANCY OUTCOMES

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Prevention is essential to improving reproductive and birth outcomes

Increasing Awareness is the first step to a thousand mile journey!

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the question
THE QUESTION
  • How can preconception health care be made a priority and feasibly implemented at an Academic Medical Center, namely the
  • University of Nebraska Medical Center?

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Make it relevant!

University of Nebraska Medical Center

EDUCATION: Increase Awareness of Life-course Perspective and Connection to Preconception Care

INCLUSIVITY: Get input and perspective from those that do the work

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the process approach and methods
The Process (Approach and Methods)
  • Department of Ob/Gyn secured funding from Nebraska HHS Lifespan Health Services (Title V).
  • Establish a planning committee with representatives from IM, Psych, FM, PH, HD
      • Identified Objectives and Audience
      • Developed content and format
      • Marketing and Promotion

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seminar launched october 27 2011
Seminar Launched October 27, 2011
  • OBJECTIVES:
  • 1. Present NPHHC Initiative recommendations and highlight the importance and significance of preconception health in improving pregnancy and birth outcomes. Local and national data presented.
  • 2. Encourage inter-professional discourse to identify feasible and innovative solutions to incorporate preconception health care across specialties.
  • 3. Assemble an inter-professional preconception health care action committee to continue efforts post-seminar.

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seminar format
University of Nebraska Medical CenterSeminar Format:
  • I: Didactics: Preconception Health
  • What is it? Why should we care?
  • Life-course Model
  • National Recommendations
  • Local, state & national trends
  • II. Breakout Groups
  • Interdisciplinary
  • How can we successfully integrate the life course perspective and preconception health in our daily clinical practice.
  • What will/can you do today to improve the life course of women

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outcomes
Outcomes:

Participants: (UNMC, Creighton, Clarkson)

Facilitators: 5

Faculty: 11

Residents: 21

Medical Students: 16

Support Staff: 4

Total: 57

3 academic institutions representing 6 specialties

Medicine, Pediatrics, Ob/Gyn, Family Medicine, Psych, Public Health

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outcomes continued
Outcomes Continued
  • BREAKOUT GROUPS:
  • 5 inter-professional breakout groups met and proposed immediate through long-term recommendations to incorporate preconception health care in the clinical setting across specialties.

YES….BILLING and REIMBURSEMENT IS AN ISSUE

BUT WHAT CAN WE DO DESPITE THIS REALITY?

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recommendations
Recommendations
  • Put every menstruating adolescent on a daily multivitamin and iron.
  • Assess reproductive plan at every “gynecologic” visit discuss health maintenance issues like weight control and prescribe PNV with every birth control prescription.
  • Discuss post partum planning prior to delivery including post partum contraception, multivitamin use, and reproductive plan.
  • Facilitate increased communication between Ob/Gyn and Pediatrics. Interdisciplinary rounds.
  • Discuss life course plan with mother at newborn visit and with adolescents at 12y and 18 y visits. (PEDS)

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recommendations continued
Recommendations Continued:
  • Engage fathers at well baby and well women visits
  • Work closer with social work to address patient social contributors
  • Increase awareness of preconception and inter-conception in the pediatric setting
  • Arrange newborn visits with pediatrics at 37 weeks
  • Get an MPH….and more involved.
  • Establish an action committee to progress with recommendations with representation from faculty and residents.

“ I am being expected to do more and more with less and less. I am already maxed out!”

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committee progress 7 person
Committee Progress (7 person)
  • Bi-Monthly meetings to prioritize recommendations and address them on a timeline.
  • Abstract submissions for presentations to increase awareness
  • Purchased life course model board game and will use at resident retreats
  • Incorporate life course perspective in grand round presentations and didactic sessions in Peds, FM, Ob/Gyn and Psych
  • Increase awareness amongst patient population…community presentations (Charles Drew Community Health Center)
  • Plan Fall 2011 seminar on preconception/interconception care and life course model with invited guest (tentative Michael Lu)

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life course perspective
Life Course Perspective

Progress in the Department of Ob/Gyn

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  • Pre 1st conception
    • All women of reproductive age
    • Annual Exams
    • Well Child visits of adolescents
  • Interconception
    • Prenatal visits
    • Post-Partum Visits
    • Annual Exams
  • Teach the importance of improving preconception health
    • Decrease rates of pregnancy complications
    • Decrease childhood disease in their offspring
    • Decrease adult disease in their offspring
    • Improve the health of future generations
life course perspective1
Life Course Perspective

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  • Reproductive Life Plan:
    • How many children do they desire?
    • When would they ideally like their first or next

pregnancy to occur?

    • How would an unintended pregnancy affect other educational or professional goals?
  • What do they need to do to achieve these goals:
    • Sexual health plan
    • Contraception
    • Encourage Education
  • DON’T FORGET ABOUT THE MEN
life course perspective2
Life Course Perspective

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  • Counseling women about:
    • Achieving a Healthy Weight
    • Getting Chronic diseases under control prior to conception
    • Smoking Cessation
    • Taking folic acid/prenatal vitamins
    • Avoidance of Environmental Toxins
    • Appropriate contraception options in the mean time
    • Importance of timely prenatal care once she is pregnant
    • Breastfeeding
    • Help identify misconceptions she might have
next steps
Next Steps
  • Committee will continue to meet bi-monthly
  • Solidify plans for Fall seminar with Dr. Michael Lu
  • Grand Round presentations for interdisciplinary rounds between Departments of IM, Ped, Psych, FM, and Ob/Gyn regarding life course perspective and preconception/interconception care.
  • Expand the H&P on Ob/Gyn to include reproductive life plan and goals.
  • Encourage consistent BMI calculation (height and weight)

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special thanks recognition
University of Nebraska Medical CenterSpecial Thanks & Recognition
  • Nebraska HHS Lifespan Health Services (Title V)
  • Rachel Bonnema, MD, MS
  • Libby Crockett, MD
  • David Crouse, Ph.D
  • Janice Golka
  • Sharon Hammer, MD
  • Amy Lacroix, MD
  • Magda Peck, ScD
  • Marvin Stancil, MD
  • Serena Wu, MD

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Renaisa S. Anthony MD, MPH

University of Nebraska Medical Center

Center for Reducing Health Disparities

College of Public Health

[email protected]

402 559-9660

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