Implementing Preconception Health Care in Clinical Settings:

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

Renaisa S. Anthony MD, MPHDeputy Director, Center for Reducing Health DisparitiesAssistant Professor, UNMC COPH(402) 559-5327renaisa.anthony@unmc.eduJune 13, 2011 1

Welcome to Nebraska

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

1 School (AH)

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CherryHolt

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Pawnee Richardson

Nemaha

Thurston

Johnson

Sarpy

Douglas

Dakota

Washington

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0 90 18045Miles

Type of County

Frontier County

Urban County*

Sources of data: U.S. Census Bureau, Population Per Square Mile Census 2010 Population Census. Nebraska Health Planning Regions defined by Nebraska Health and Human Services System, 2001. Federal Office of Management and Budget designation of Metropolitan and Micropolitan, 2003. U.S. Census Bureau, frontier definition, 2001.

Produced by: University of Nebraska Medical Center, College of Public Health Department of Health Services Research and Administration, 2011.

Cartography: Nicole Vanosdel, Medical Geographer, 2011.

Population DensityPer County;Nebraska 2010

0.6 - 7.0

7.1 - 100.0

100.1 - 500.0

500.1 - 1521.8

Population Density Per County; Nebraska 2010

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

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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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 work9

Make it relevant!

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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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.

Seminar Launched October 27, 2011

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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 women12

Outcomes:

Participants: (UNMC, Creighton, Clarkson)Facilitators: 5

Faculty: 11

Residents: 21

Medical Students: 16

Support Staff: 4

Total: 57

 

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3 academic institutions representing 6 specialtiesMedicine, Pediatrics, Ob/Gyn, Family Medicine, Psych, Public Health

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.

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YES….BILLING and REIMBURSEMENT IS AN ISSUE

BUT WHAT CAN WE DO DESPITE THIS REALITY?

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:• 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.

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

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) 17

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Life Course PerspectivePre 1st conception

1. All women of reproductive age

2. Annual Exams

3. Well Child visits of adolescents

Interconception4. Prenatal visits

5. Post-Partum Visits

6. Annual Exams

Teach the importance of improving preconception health7. Decrease rates of pregnancy complications

8. Decrease childhood disease in their offspring

9. Decrease adult disease in their offspring

10. Improve the health of future generations

Progress in the Department of Ob/Gyn

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Life Course PerspectiveReproductive Life Plan:

1. How many children do they desire?

2. When would they ideally like their first or next

pregnancy to occur?

3. How would an unintended pregnancy affect other educational or professional goals?

What do they need to do to achieve these goals:4. Sexual health plan

5. Contraception

6. Encourage Education

DON’T FORGET ABOUT THE MEN

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Life Course PerspectiveCounseling women about:

1. Achieving a Healthy Weight

2. Getting Chronic diseases under control prior to conception

3. Smoking Cessation

4. Taking folic acid/prenatal vitamins

5. Avoidance of Environmental Toxins

6. Appropriate contraception options in the mean time

7. Importance of timely prenatal care once she is pregnant

8. Breastfeeding

9. Help identify misconceptions she might have

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Next Steps

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• 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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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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Renaisa S. Anthony MD, MPHUniversity of Nebraska Medical CenterCenter for Reducing Health Disparities

College of Public HealthRenaisa.anthony@unmc.edu

402 559-9660