262488 Improving prenatal care access in South Georgia African-Americans does improve perinatal outcomes

Wednesday, October 31, 2012

Jacqueline Grant, MD, MPH, MPA , Department of Public Health, State of Georgia, Southwest Health District, Albany, GA
Karen Baker, FNP-C , Dougherty County Health Department, Albany, GA
VaLenia Milling, RN , Dougherty County Health Department, Albany, GA
Denise Linnekohl, RN, BSN , Colquitt County Health Department, Moultrie, GA
Nancy Rumph , Department of Public Health, State of Georgia, Albany, GA
Nettie Lilly , Dougherty County Health Department, Albany, GA
Georgia's Southwest Public Health District serves a 14 county population of approximately 360,000 people, roughly 41.1% African-American and 57.8% Caucasian. The District's lead county, Dougherty, is 63.7% African-American and serves as the medical hub of a predominantly rural district. In 2006, the District's African-American infant mortality rate was 15.2 – more than triple the Caucasian rate (4.7). The 2008 Georgia Health Disparities Report noted the percentage of Dougherty's African-American low birth weight infants was 14.1, compared to the county rate of 8.4 and issued the county an F for inadequate prenatal care. With the loss of three high volume Medicaid obstetricians, the District initiated a public-private healthcare delivery model to expand low-income African-American women's access to early prenatal care in an effort to improve perinatal outcomes. After ascertaining collaborative agreements with four obstetric practices for after hour emergency care, prenatal care referral (routinely at 35 weeks) and delivery services, in October 2009 Dougherty County Health Department began CenteringPregnancy®, an evidenced-based model of group prenatal care. Since its inception, 177 new ob exams were completed and 62% of patients received ≥ four visits prior to transfer. The mean age is 22.6. 87% are African-American. The mean gestational age at the initial prenatal visit is 10 6/7 weeks. 6.9% had low birth weight infants compared to the above noted baseline rates. The centering patient's breastfeeding initiation rate of 68% compares favorably with the county WIC rate of 39%. These results demonstrate that early access to patient-centered prenatal care improves perinatal outcomes.

Learning Areas:
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Program planning
Public health or related nursing
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Describe the barriers to early entry into prenatal care for South Georgia low-income women 2.Describe a public health-private practice collaboration developed and sustained to improve prenatal care access 3.Demonstrate the effectiveness by comparing preliminary birth outcomes data and breastfeeding rates

Keywords: Access, Prenatal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I authored the March of Dimes grant which funded the CenteringPregnancy® Program at the Dougherty County Health Department. In addition to serving as the District Public Health Director, I am a practicing board certified obstetrician and oversee the clinical and evaluation aspects of the program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.