DOING PRECONCEPTIONAL HEALTH: LOCAL REALITIES

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DOINGPRECONCEPTIONAL HEALTHLOCAL REALITIES

• Marjorie Angert, D.O., MPH,
• Director of Medical Affairs,
• Division of Maternal, Child and Family Health,
  Philadelphia Department of Public Health

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PHILADELPHIA INFANT MORTALITY, 1995-1998
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Philadelphia PPOR Results,1997-99 (95 C.I.)
Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health
Lower North HS   10.7 (8.1-13.8)   3.8 (2.3-5.9)   2.7 (1.5-4.5)   3.6 (2.2-5.6)
All Phila. n65,849 5.6 (5.0-6.2) 2.9 (2.5-3.3) 1.4 (1.1-1.7) 2.3 (2.0-2.7)
Reference n8233 2.1 (1.2-3.3) .85 (.3-1.8) .85 (.3-1.8) .61 (.2- 1.4)
Philadelphia Residents, White, non-Hispanic,
13years of education, 20 years of age
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PHASE II ANALYSIS

• Chronic Hypertension
• Previous Preterm Delivery
• High Parity for Maternal Age

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PARTNERS ASSEMBLED

• Philadelphia Department of Public Health
  (Division of Maternal, Child and Family Health)
• Healthy Start Staff
• Health Clinic Providers and Staff
• North Philadelphia Alliance

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LINKING PPOR TO THE COMMUNITY

• Healthy Start has been working with the North
  Philadelphia Alliance (community board) medical
  providers, patients, CBOs, faith-based
  organizations
• Team presented PPOR to the Alliance
• Alliance and local partners learned risk factors
  for prematurity and infant mortality in their
  community

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PUTTING TOGETHER LOCAL TEAM

• Team identified local partners for strategic
  planning at the health center
• MCFH staff medical director and administrator
  for family planning/gyn services HS program
  manager, Consortium developer and epidemiologist
• Health Center staff administrator, medical
  director, health care coordinator, family
  planning nurse practitioner, gynecologist,
  primary care provider, clerical staff and social
  worker

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INTERVENTION STRATEGIES

• Strategies will include the Healthy Start case
  manager and require collaboration between family
  planning and family medicine
• 1. Women with a positive or negative pregnancy
  test will be connected with Healthy Start at that
  visit.
• 2. Women seen in family planning who have
  medical risk factors for preterm birth will be
  referred to Adult Medicine for treatment and to
  Healthy Start for education and coordination of
  interconceptional care.
• 3. Women with history of preterm birth will be
  referred to Healthy Start for education and, if
  needed, case management services.

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INTERVENTION STRATEGIES (cont.)

• 4. We will meet with primary care staff to
  discuss their role in decreasing infant mortality
  through preconceptional care
• Medical conditions and social behaviors predate
  the pregnancy
• 40-50 of pregnancies are unplanned
• Need to integrate preconceptional screening into
  H P

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BARRIERS

• Lack of knowledge among community and medical
  providers about the importance of preconceptional
  care
• Limited opportunities to meet with medical staff
• Lack of screening tool for risk factors for
  medical providers
• Inadequate staff

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BARRIERS (cont.)

• Complicated consent and confidentiality issues
  when two organizations (Health Center and Healthy
  Start) collaborate
• Need to understand at an emotional level what it
  is like to have a premature baby or an infant
  death

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LESSONS LEARNED

• PPOR data is powerful, but is only the first step
• All partners must be at the table early on and be
  part of the process
• Have the meetings on site and at regular
  intervals
• Recognize that the program evolves over time - it
  is a process

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LESSONS LEARNED

• Community involvement is critical
• Look for help from the institutions in your city
• Evaluation is an important part of the process