EPIC%20Breastfeeding%20Program

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EPIC Breastfeeding Program

Breastfeeding Education
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EPIC

• Educating Physicians and Practices In Their
  Community
• Began in 2007
• Peer-to-Peer Physician Breastfeeding Education
• Patterned after the EPIC Immunization Program
• EPIC Breastfeeding Program hopes to mirror its
  success

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EPIC BreastfeedingProgram Partners

• Georgia Department of Public Health
• Georgia Chapter American Academy of Pediatrics
• Georgia Ob/Gyn Society
• Georgia Academy of Family Physicians
• Centers for Disease Control and Prevention

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Goals of EPIC Breastfeeding Program

• Educate physicians their office staff on
  breastfeeding
• Give reasons why physicians play a critical role
• Teach evidence - based standards on how to
  encourage, promote and support breastfeeding
• How to access lactation and support services in
  the community
• How to access patient education resources
• Inform physicians of WIC services for
  breastfeeding mothers

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CDC Breastfeeding Report Card
Georgia 2007 2009 2010 2012 2013 2014
Breastfeeding Initiation 68.2 62.5 62.8 70.9 68.2 70.3
Breastfeeding _at_ 6 months 38 36.4 33.5 40.8 31.8 40.1
Breastfeeding _at_ 12 months 16.8 18.1 17.9 17.6 12.9 20.7
Exclusive Breastfeeding _at_ 6 months 11 14.8 9.7 12.9 6.2 14.5
Baby Friendly Hospitals 0 0 0 0 0 3
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Why is educating physicians on breastfeeding
important?

• women typically receive minimal advice about
  breastfeeding from a physician. Freed et al
• Physicians lack the necessary clinical skills to
  provide lactation management Taveras et al.
• Pediatricians are ideally situated to positively
  influence the breastfeeding experiences of the
  mother and young infant. Hillenbrand et al.

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Challenges for Physicians

• Not aware of benefits/management
• Lack of time
• Concerns about reimbursement
• Not comfortable examining breasts
• No knowledge of community
• resources

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Breastfeeding Advisory Group

• Eight members
• Meet quarterly
• Develop the curriculum
• Annual updates to curriculum
• Develop additional programs as needed
• Provide expert resource

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EPIC Trainers

• Physicians, Nurses, Dieticians Lactation
  Consultants
• Must be skilled with breastfeeding management
• Complete a train the trainer education module
• Can be done with group or individual
• Covers curriculum, set-up, maintenance of
  equipment and other logistics
• Physicians and a lactation specialist are a team
  and are paired to deliver the program
• Trainers meet twice a year with the EPIC director
• Trainers receive feedback and evaluations of
  their performance
• Discuss any updates and offer suggestions for
  curriculum changes
• Trainers are given modest stipend and travel
  reimbursement

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EPIC Program

• One hour EPIC Breastfeeding Program
• Delivered through PowerPoint Presentation with
  script
• Presented in
• Doctors office
• Hospitals
• Residencies
• Health Departments/WIC
• Goal is 6 programs a month
• Resource materials are left behind for the office
  to encourage, promote support breastfeeding

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Resources

• Each office or program receives breastfeeding
  resources
• Books
• Handouts
• Coding information
• WIC information
• List of community
• resources

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Target Counties

• Bibb
• Laurens
• Richmond
• Clayton
• DeKalb
• Fulton
• Cobb
• Thomas
• Gwinnett
• Muscogee
• Chatham

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Marketing our Program

• GA AAP Board meetings
• Blastfaxes
• Exhibiting at conferences
• Send out mailings to previous program recipients
  to take a different program
• Trainers and Advisory members encourage programs
• Close ties with the WIC and Health Departments
• Word of Mouth

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Evaluation

• Pre-program survey
• Assessing physician knowledge and practices
• Program survey
• Participant evaluation form
• Evaluate curriculum
• Evaluate trainer effectiveness
• Seek areas of interest
• Post- program survey (60 day F/U)
• Access program quality and content
• Access knowledge gained
• Changes in practice behavior

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EPIC Breastfeeding Programs

• Breastfeeding Fundamentals
• Supporting Breastfeeding in the Hospital
  Setting
• Advanced Breastfeeding Support

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Breastfeeding Fundamentals

• Challenges for Physicians
• Realistic expectations
• Racial disparities
• Benefits of breastfeeding
• Latch
• Positioning
• Milk transfer

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Fundamentals

• Breastfeeding at delivery
• Prenatal visit (emphasis on the OBs role)
• Postpartum routine
• Most common problems
• Sore nipples
• Mastitis
• Maternal emotions
• Medications

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Fundamentals

• Hot Topics
• Co-sleeping
• Milk sharing
• Pacifiers
• Supplementing
• Contraception
• Starting solids
• Questions

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Supporting Breastfeeding in the Hospital

• Benefits of breastfeeding
• Obstacles to breastfeeding
• Baby Friendly
• 10 steps
• Policy
• Joint commission and mPINC scores
• After delivery
• Skin to skin
• Exclusive breastfeeding
• Documentation

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Hospital Program

• Separation of mom and baby
• Pumping/hand expression
• Kangaroo Care/NICU
• Barriers
• Discharge bags
• Follow-up and support
• WIC
• Food packages
• Services for breastfeeding mothers
• Community Resources

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Advanced Breastfeeding Support

• How do you know if a mother is producing enough
  milk?
• Breast changes
• Urine and stool output
• How can a mother increase her milk supply?
• Evaluating a feeding
• Pumping/hand expression
• Galactogues/medications
• What can mothers do to prevent or treat sore
  nipples?
• LATCH
• Engorgement
• Nipples problems

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Advanced Program

• When supplements are indicated, how does a mother
  supplement without interfering with
  breastfeeding?
• Maternal issues
• Infant factors
• When to supplement
• When
• How
• Methods
• How does the pre-term infant differ in their
  ability to breastfeed?
• Define pre-term infant
• Feeding issues

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Results

• 548 programs
• 1,590 physicians trained
• 24.3 are physicians
• 6,889 total trained
• 29 held in focus counties
• 99.3 of practices would recommend the training
  to other physicians

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Future ideas of EPIC

• Three hour hospital curriculum
• NICU curriculum
• Infant feeding curriculum
• More emphasis on OBs and breastfeeding
  support/WIC referrals
• Need more physician data on breastfeeding rates
• Working with businesses to set up lactation rooms

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Questions?