Implementing Preconception Health Care in Clinical Settings:

1. 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 1

2. Welcome to Nebraska 2

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

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6. 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 6

7. Prevention is essential to improving reproductive and birth outcomes Increasing Awareness is the first step to a thousand mile journey! 7

8. 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? 8

9. 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 9

10. 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 10

11. 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. 11

12. 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 12

13. 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 13

14. 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? 14

15. 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) 15

16. 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!” 16

17. 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

18. Life Course Perspective Progress in the Department of Ob/Gyn 18 • 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

19. Life Course Perspective 19 • 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

20. Life Course Perspective 20 • 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

21. 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) 21

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23. 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 23

24. 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 24