Providing mifepristone with misoprostol for early pregnancy loss (EPL) management in primary care is safe, effective, and evidence-based. However, FDA regulations on mifepristone, particularly requiring dispensing in-office as opposed to via prescription, inhibits provision in primary care. We describe these restrictions’ effects on 1) primary care clinicians’ abilities to provide EPL management, and 2) patient care.

Cross-sectional online survey of US primary care clinicians with prescribing authority who subscribe to one of six reproductive health-focused listservs. Mixed methods survey queried about experiences with and perceptions of barriers to providing mifepristone. For analysis, we utilized descriptive statistics and grounded theory.

Participants (N=144) included family physicians (59.7%) and advanced practice clinicians (23.6%). Most (90.3%) knew that mifepristone with misoprostol is more effective than misoprostol alone for medication management of EPL. Mifepristone was unavailable in 63.2% of respondents’ current practices. Of those, 93.4% would provide medication management of EPL if they could write a mifepristone prescription. Respondents wanted to provide mifepristone, but experienced three main barriers: resistance from health center leadership, “bureaucratic hurdles” to stocking mifepristone, and – due to the association between abortion and mifepristone – federally qualified health centers perceive risks to federal funding if they stocked mifepristone. These FDA-related barriers resulted in negative patient care experiences, including: disrupted continuity of care, unnecessary invasive procedures, exacerbated emotional distress, and added inequities in health care access.

FDA regulations on mifepristone restrict provision of safe, effective EPL management in primary care. Removing them may increase access to EPL care and improve patient experiences.

Background: Since the onset of the opioid epidemic, the prevalence of opioid use disorder (OUD) among pregnant women has increased along with rates of neonatal abstinence syndrome (NAS). Innovative rooming-in programs that optimize perinatal health outcomes for mothers with OUD and their infants with neonatal abstinence syndrome (NAS) have been developed. Knowledge is lacking about barriers and facilitators to adopting such programs.

Objective: To describe barriers and facilitators experienced by South Carolina hospitals adopting a rooming-in model for women with OUD and infants with NAS.

Methods: Qualitative semi-structured interviews were conducted at three hospital sites (community, acute care, rural) prior to program implementation with doctors (n=7), nurses (n=23), pharmacists (n=3), and case managers/social workers (n=4). The study team independently coded transcripts, conducted thematic data analysis, and constructed themes in Atlas.ti v8.

Results: Barriers and facilitators of adoption included stakeholder buy-in and identification of program champions. Perceived advantages of program adoption included benefits of keeping the mother-baby dyad together. Moving from current care processes to the new program, time and staffing constraints, and lack of space were mentioned as primary disadvantages to model adoption and implementation. Current Medicaid payment structures further prohibited adoption of the rooming-in model.

Conclusion: Efforts to expand rooming-in programs for women with OUD and infants with NAS should focus on identifying champions who endorse and accelerate change. Stakeholders must perceive relative advantages of adopting such programs. Value-based payment models have the potential to provide critical resources for overcoming barriers related to staffing and space.

Background: Health literacy (HL) reflects individuals’ ability to understand and apply health information in healthcare navigation including diagnosis, treatment, and follow-ups, with an estimated one-third of the United States population with health illiteracy (HiL). Despite the importance of HiL in general health (GH), quality of life (QoL), and the impact on health disparities, there are no large pediatric sample data in pediatric setting . The current study aimed to examine HiL prevalence , assess the relationship between HiL and GH and QoL as well as the racial heterogeneity in the correlation.

Methods: A cross-sectional design on 304 survey participants (caregivers/guardians of children) was utilized in assessing the postulated correlation. The variables examined were HL,HiL, QoL, GH, and socio-demographics . The Mantel-Haenszel stratification analysis and logistic regression model were used for confounding assessment and risk prediction respectively.

Result: The prevalence of HiL was estimated at 77.3%, 95% Confidence Interval (CI) = 72.9-81.3. There was an inverse correlation between HiL and the GH, with HiL associated with significant 52% less likelihood of good GH, prevalence odds ratio (POR) = 0.48, 95% CI= 0.28-0.83. After controlling for the confoundings in the association between HiL and GGH, there remained a clinically meaningful risk of poor GH given HiL, adjusted POR (aPOR) = 0.48, 99%CI = 0.23-1.02). Additionally, there was a marginal increase in poor QoL given HiL, aPOR, 1.03, 99%CI, 0.42-2.50.

Conclusion: HiL is relatively high in a representative sample of families and caregivers of children in a pediatric healthcare setting, and inversely correlated with GH and QoL

background: Social determinants of health (SDoH) are key drivers of health care utilization which impact individual and population health equity and outcomes. It is important to study how these social and structural factors influence emergency department (ED) utilization with infants to develop a deeper understanding of the disparities in utilization rates.

methods: 2,053,852 visits from California’s Office of Statewide Health Planning and Development data and Vital Statistics Birth data between the years 2008-2012, were analyzed for associations between the SDoH, timing of visits, and diagnoses when infants utilized emergency care. Descriptive analysis, logistic regression, and chi-squared tests were used for the study.

results: Infants with Medicaid, self-pay insurance, and from frontier areas were noted to have a higher preference for ED utilization during the neonatal period, than any other time during infancy. Black and Hispanic infants and infants with Medicaid had more ED visits during the workweek than their Non-Hispanic White, privately insured counterparts. No specific group had only non-urgent visits, but each group had a unique primary diagnosis.

conclusion: The increased ED utilization associated with the SDoH of ethnicity, insurance type, and rurality may be due to parents experiencing difficulty negotiating barriers to primary care services or a knowledge deficit. This information will assist health care providers with developing interventions to reduce ED visits and improve access to primary care for our most vulnerable populations. Further research into the impact of the SDoH on infant health care utilization is needed, along with improved SDoH data collection by healthcare institutions.

Background: In Russia, rates of maternal and newborn mortality exceed the levels observed in the developed countries of Europe. It demonstrated greater variability in different regions of the country, with the highest mortality rates in the rural and remote populations. In this systematic review, we aim to collate and summarize the factors that are associated with the access and utilization of maternal, newborn and child health (MNCH) services in Russia.

Methods: We conducted a systematic search in MEDLINE, Web of Science, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, SocINDEX, Cochrane Library, DARE, NHS EED, HTA, and Grey Literature. We included all published papers in the English language up till November 2019.

Results: We included 43 studies out of 716 identified articles. The access and utilization of MNCH services in Russia are affected by the following: (1) maternal factors (e.g., education, parental health, personal relations of trust); (2) health professional factors (e.g., paternalistic counseling, lack of concern on mothers’ psychosocial needs, medicalization of maternity care); (3) socio-cultural factors (e.g., social strata, traditional practices, societal support); and (4) structural factors (e.g., lack of resources, institutional support, woman-friendly environment, family-centered care services).

Conclusions: In Russia, access and utilization of MNCH services are affected by maternal, health professional, socio-cultural, and structural factors. It is imperative to optimize the maternity care system by providing appropriate resources and institutional support, as well as increasing its quality of services. Improving the relationship between mothers and health professionals is essential to ensure the continuum of care.

Background: The Department of Defense (DoD) Military Health System (MHS) strives to understand beneficiary experience to inform the delivery of patient-centered care within a high-quality health system. Although many studies have assessed drivers of the hospital birth experience, few have examined the qualitative experiences of new mothers who received their obstetric care within the MHS.

Methods: We conducted an analysis of qualitative data provided by women whose inpatient birth experience took place within a military treatment facility (MTF) during January-June 2018. These qualitative data were extracted from responses to open-ended questions on the TRICARE Inpatient Satisfaction Survey (TRISS), a large patient experience survey fielded regularly by DHA to all patients who have had a hospital visit.

Results: A total of 1,140 obstetric inpatient comments reflecting experiences at 18 military hospitals across the all service branches served as the data source. Comments were coded using Nvivo 11 qualitative analysis software, and themes were analyzed by facility and service branch. Findings reflected those from similar studies at civilian hospitals. Qualitative drivers of patient experience included provider-patient communication, specifically regarding a need for clear instructions and communications; patient inclusion in decision making, attentiveness and demonstration of empathy and care of staff; cleanliness and comfort of the accommodations; and timeliness of care and administrative processes.

Conclusion: Provider engagement and physical environment are two general themes that influence obstetric patient’s experience of care in military hospitals. Recommendations on improving patient experience can be gleaned from more detailed patient comments in addition to quantitative experience measures.

Background: The Baby-Friendly Hospital Initiative (BFHI) has support from numerous policy and regulatory bodies and has been shown to be an effective intervention to encourage women to initiate breastfeeding at the time of birth. Research also supports this program as an intervention to promote the duration and exclusivity of breastfeeding. A significant gap in knowledge of factors that promote or block BFHI adoption and implementation exists.

Research Aim: To identify the greatest barriers to and facilitators of the adoption and implementation of the BFHI in the US.

Methods: This was a cross-sectional study using a purposive sample of perinatal health care specialists in multiple states across the US. Respondents were recruited via statewide or regional breastfeeding organizations and invited to complete an online survey.

Results: 256 respondents from 12 states completed the survey. Many organizational and policy factors that support adoption and implementation of the BFHI were identified. Some of the main facilitators of adoption and implementation included sufficient resources, workforce training, participation in statewide perinatal quality improvement collaboratives, and clearly stated goals from organizational leaders. Some of the barriers were a lack of financial support from outside organizations, insufficient organizational resources to support the costs of the program, and lack of buy-in from clinicians.

Conclusion: This study lays the groundwork for further inquiries into the targeted identification of the greatest barriers and facilitators of adoption and implementation of the BFHI and can provide guidance to administrators and clinicians.

INTRODUCTION: Parents invest substantial resources in raising and caring for their children. Among these investments, parents seek medical care and advice regarding their child's health and development from the healthcare system and their own social networks. Equally important, children are at risk for experiencing the consequences of structural vulnerability and resultant health disparities due to long standing inequities in the availability and accessibility of resources necessary for optimal health. We use a public health critical race lens to: 1) examine cultural health capital among parents; and 2) identify how they leverage a range of resources, often from marginalized and structurally vulnerable positions, to secure desired care.

STUDY DESIGN: Focus groups with English and Spanish speaking parents/caregivers of children ages 0-6. Questions explored parent perceptions of health care access, delivery, and early childhood development.

SETTING: Community-based organizations and primary care clinics, including family medicine residency programs

RESULTS: We conducted 9 groups with 61 parents representing geographic, language, and clinic diversity. Results indicate that previous positive and negative experiences (e.g. bias, physician relationship, cost of care) shape parent perceptions of and expectations for pediatric care. Parents also employ ingenious and creative coping strategies to negotiate access to pediatric care.

CONCLUSION: The experiences of community residents who have been traditionally disenfranchised and disempowered provide insight into the factors that facilitate and hinder child development and pediatric care access. These findings can inform clinic procedures, policy evaluation, and community engaged interventions to improve early child development outcomes.

Background: Maternal vaccination offers optimal protection against severe morbidity and mortality from influenza and pertussis for mothers and their infants. Despite the health benefits, coverage of recommended vaccines among pregnant women remains low in the US. While disparities in adolescent immunization rates have been previously described, maternal immunization rates in rural US communities have not yet been evaluated.

Methods: We analyzed data from the 2012-2018 Pregnancy Risk Assessment Monitoring System (PRAMS) for 42 US states and New York City. PRAMS is a state-specific, population-based survey of maternal experiences before, during and after birth. Rurality was assessed based on the National Center for Health Statistics definition of urban vs. rural residence. Weighted percentages and corresponding 95% confidence intervals (CIs) are reported. We estimated the odds of influenza and pertussis vaccination for urban vs. rural-residing women using logistic regression.

Results: Information was available for 250,366 participants on influenza vaccination, and 42,806 participants on pertussis vaccination; 14.5% (95% CI 14.3-14.7%) of women resided in a rural area. In total, 44.7% (95% CI: 44.4-45.0%) of women received an influenza vaccine and 42.4% (95% CI: 41.7-43.1%) received a pertussis vaccine during pregnancy. The odds of vaccination were 21-23% lower in women residing in rural areas compared to urban (influenza: OR: 0.79; 95% CI: 0.77-0.83; pertussis: OR: 0.77; 95% CI: 0.69, 0.86).

Conclusion: Our results indicate that pregnant women residing in rural communities have lower rates of immunization. Further research is needed to identify specific barriers to immunization in rural areas that could allow targeted intervention.

Background: Recent research estimates that one-third of U.S. women giving birth experience post-traumatic symptoms associated with birth, resulting in potential long-term negative effects for themselves and their infants. However, birth trauma research traditionally has focused on patient perspectives and rarely explores the experiences of maternity healthcare professionals or the effects of patient birth trauma on clinicians.

Methods: We recruited a purposive sample of maternity healthcare professionals for semi-structured interviews exploring their experiences of patient birth trauma. A thematic analysis was completed, framed within the social ecological model to explore contextual factors associated with birth trauma.

Results: Twenty-eight participants completed interviews, including labor and delivery nurses (n=14), midwives (n=8) and physicians (n=6). Major themes that clinicians associated with patient birth trauma included 1) lack of provider training in responding to patients’ emotional needs; 2) lack of structure for processing their own emotions after patient trauma; 3) lack of one-to-one nursing, 4) limited patient preparation, 5) poor communication, 6) lack of continuity of care and patient-centered care, and 7) lack of informed consent. Additionally, participants described their own experiences of secondary trauma, compassion fatigue, burnout and moral distress associated with patient birth trauma experiences.

Conclusion: Findings reinforce the need to address contextual and systemic factors associated with birth trauma and provide adequate support to clinicians as well as to patients. Providers identified contextual factors associated with increased risk of patient birth trauma, such as high patient ratios, as factors that also can hinder providers’ ability to manage their own responses to birth trauma.