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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

  • 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

renaisa.anthony@unmc.edu

June 13, 2011

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Implementing preconception health care in clinical settings

Welcome to Nebraska

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Implementing preconception health care in clinical settings

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Implementing preconception health care in clinical settings

UNMC (1 of 4 UN Campuses) 5 Colleges (M, N, D, PH, P)

1 School (AH)

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Implementing preconception health care in clinical settings

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Implementing preconception health care in clinical settings

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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Implementing preconception health care in clinical settings

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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Implementing preconception health care in clinical settings

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 Center

Seminar 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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Implementing preconception health care in clinical settings

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Special thanks recognition

University of Nebraska Medical Center

Special 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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Implementing preconception health care in clinical settings

Renaisa S. Anthony MD, MPH

University of Nebraska Medical Center

Center for Reducing Health Disparities

College of Public Health

Renaisa.anthony@unmc.edu

402 559-9660

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