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335125
Improving Pregnancy Outcomes Through Interconception Care at Well Child Visits: Findings from Early Implementation


Tuesday, November 3, 2015

Pranav Kapoor, MD, Family Medicine Residency Program, Middlesex Hospital, Middletown, CT
Brittany Penner, MD, Family Medicine Residency Program, Middlesex Hospital, Middletown, CT
Renee DeRosa, MD, Family Medicine Residency Program, Middlesex Hospital, Middletown, CT
Adriel Kramer, MD, Family Medicine Residency Program, Middlesex Hospital, East Hampton, CT
Emmanuel Kenta-Bibi, MD, MPH, Family Medicine Residency Program, Middlesex Hospital, Portland, CT
Stephanie Rosener, MD, Family Medicine Residency Program, Middlesex Hospital, Middletown, CT
Michelle Cardona, MD, MPH, Family Medicine Residency Program, Middlesex Hospital, Middletown, CT
Background: Strategies to decrease pregnancy outcomes like prematurity and low birth weight focus on prenatal care. 50% of pregnancies are unplanned. Continuous Quality Improvement (CQI) has been used to improve outcomes. Screening/interventions for depression, tobacco, shortened pregnancy interval, and folic acid have evidence for improving outcomes. Interconception care (ICC) during well child visits (WCV) has potential to improve outcomes.

Methods: As part of a multi-residency CQI project, our family medicine residency updated WCV templates to include structured fields to screen mothers for depression, smoking, folic acid and contraception.  Mothers accompanying children up to age two to WCVs at three outpatient practices were screened for risk factors over twelve months.  Risks factors were addressed through brief intervention or referral.

Results:  307 mothers were screened for depression, 317 for smoking, 311 for folic acid and 268 for contraception.  10.4% had a positive 2-item depression screen and 7 had a PHQ-9 score greater than 10. Five were in treatment for depression.  18.9% of mothers smoked and 66.7% of these were counseled.  Of 44.7% not taking folic acid, 66.2% received intervention.  83.7% of mothers did not desire pregnancy, 19.4% were not using contraception.

Conclusions:  WCVs provide an opportunity to deliver ICC to mothers who may not seek care. Interventions improve maternal and child health and reduce unintended pregnancies and their complications. Practice-wide CQI strategy will increase rates of screening and intervention.  This type of quality improvement strategy can easily be applied in various settings and communities wherever care is provided to children.

Learning Areas:

Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Provision of health care to the public

Learning Objectives:
Identify risk factors that can result in poor birth outcomes. Describe the utility of providing interconception care during well child visits to to improve birth outcomes.

Keyword(s): Maternal and Child Health, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a senior resident in a family medicine residency program involved with a quality improvement team aimed at improving maternal health and pregnancy outcomes. I am trained to and provide both prenatal and well child care. I have presented posters at various professional conferences on topics including maternal health.
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.