Doing preconceptional health local realities
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DOING PRECONCEPTIONAL HEALTH: LOCAL REALITIES. Marjorie Angert, D.O., MPH, Director of Medical Affairs, Division of Maternal, Child and Family Health, Philadelphia Department of Public Health. U. p. p. e. r. N. E. R. o. x. b. o. r. o. u. g. h. /. G. e. r. m. a. n. t. o.

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Doing preconceptional health local realities

DOINGPRECONCEPTIONAL HEALTH:LOCAL REALITIES

Marjorie Angert, D.O., MPH,

Director of Medical Affairs,

Division of Maternal, Child and Family Health, Philadelphia Department of Public Health


Philadelphia infant mortality 1995 1998

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PHILADELPHIA INFANT MORTALITY, 1995-1998


Philadelphia ppor results 1997 99 95 c i
Philadelphia PPOR Results,1997-99 (95% C.I.)

*Philadelphia Residents, White, non-Hispanic, 13+years of education, 20+ years of age


Phase ii analysis
PHASE II ANALYSIS

  • Chronic Hypertension

  • Previous Preterm Delivery

  • High Parity for Maternal Age


Partners assembled
PARTNERS ASSEMBLED

  • Philadelphia Department of Public Health (Division of Maternal, Child and Family Health)

  • Healthy Start Staff

  • Health Clinic Providers and Staff

  • North Philadelphia Alliance


Linking ppor to the community
LINKING PPOR TO THE COMMUNITY

  • Healthy Start has been working with the North Philadelphia Alliance (community board): medical providers, patients, CBOs, faith-based organizations

  • Team presented PPOR to the Alliance

  • Alliance and local partners learned risk factors for prematurity and infant mortality in their community


Putting together local team
PUTTING TOGETHER LOCAL TEAM

  • Team identified local partners for strategic planning at the health center:

    MCFH staff: medical director and administrator for family planning/gyn services; HS program manager, Consortium developer and epidemiologist

    Health Center staff: administrator, medical director, health care coordinator, family planning nurse practitioner, gynecologist, primary care provider, clerical staff and social worker


Intervention strategies
INTERVENTION STRATEGIES

  • Strategies will include the Healthy Start case manager and require collaboration between family planning and family medicine:

    1. Women with a positive or negative pregnancy test will be connected with Healthy Start at that visit.

    2. Women seen in family planning who have medical risk factors for preterm birth will be referred to Adult Medicine for treatment and to Healthy Start for education and coordination of interconceptional care.

    3. Women with history of preterm birth will be referred to Healthy Start for education and, if needed, case management services.


Intervention strategies cont
INTERVENTION STRATEGIES (cont.)

4. We will meet with primary care staff to discuss their role in decreasing infant mortality through preconceptional care:

  • Medical conditions and social behaviors predate the pregnancy

  • 40%-50% of pregnancies are unplanned

  • Need to integrate preconceptional screening into H & P


Barriers
BARRIERS

  • Lack of knowledge among community and medical providers about the importance of preconceptional care

  • Limited opportunities to meet with medical staff

  • Lack of screening tool for risk factors for medical providers

  • Inadequate staff


Barriers cont
BARRIERS (cont.)

  • Complicated consent and confidentiality issues when two organizations (Health Center and Healthy Start) collaborate

  • Need to understand at an emotional level what it is like to have a premature baby or an infant death


Lessons learned
LESSONS LEARNED

  • PPOR data is powerful, but is only the first step

  • All partners must be at the table early on and be part of the process

  • Have the meetings on site and at regular intervals

  • Recognize that the program evolves over time - it is a process


Lessons learned1
LESSONS LEARNED

  • Community involvement is critical

  • Look for help from the institutions in your city

  • Evaluation is an important part of the process


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