“stir-fried” strategies for women’s health jennifer opalek, r.n., m.s.n., m.p.h. and jane...
TRANSCRIPT
“Stir-Fried” Strategies for Women’s Health
Jennifer Opalek, R.N., M.S.N., M.P.H. and Jane Bambace, M.Ed.
St. Petersburg, Florida
Part 1:
Utilizing PPOR Results to Develop Strategic Interventions
Pinellas County PPOR analysis conducted during 1998-2000.
Local
Results. . .
Feto-Infant Mortality All Births, Pinellas County, 1998-00
291
Feto-Infant Deaths
29,085
Fetal Deaths & Live Births
Maternal Health & Prematurity136 deaths
4.7
Maternal Care68 deaths
2.3
Newborn Care41 deaths
1.4
Infant Care46 deaths
1.6
Overall Rate: 10.0
Feto-Infant Mortality Black Race, Pinellas County, 1998-
00
82
Feto-Infant Deaths
4,569
Fetal Deaths & Live Births
Maternal Health & Prematurity46 deaths
10.1
Maternal Care14 deaths
3.1
Newborn Care6 deaths
1.3
Infant Care16 deaths
3.5
Overall Rate: 17.9
Excess Feto-Infant Mortality Pinellas County 1998-00
_ =
All RacesFlorida DOH Reference Excess
4.7
2.3 1.4 1.6
10.010.0
2.3
1.6 0.9 1.0
5.85.8 4.24.2
2.4
0.7 0.5 0.6
Phase 2 Analysis Findings• Kitagawa: Over HALF of excess feto-infant mortality
is due to the LARGE NUMBER of VLBW births
From Birth Certificate
Anemia
Chr. Hypertension
Smoking
Alcohol/Drugs
3rd Trimester PNC
No PNC
•Risk Factors Examined included:Risk Factors Examined included:
From Prenatal Screen
Appointments
Moved
Unsafe
Hungry
High Stress
Unwanted Pregnancy
Leading Prevention Strategy
• Provide preconceptional and interconceptional care to women of reproductive age
Program Map
Input
Activities
Outputs
Physician Referral for High Score
Outreach
Pregnancy Testing
Self Referral
Results
Physician Referral for Other Factors
Care CoordinationInterconceptional Care
Community Consortium BuildingFamily Planning
Identify stress and mental health issues
Improved Access to Healthcare for WCBA
Education on Women’s Health IssuesCounseling/Referrals
Peer Support Groups
Early Entry into Prenatal Care
Targeted Outreach
Repeat Births at Least 2 years after LastFewer Women SmokersImproved Maternal Nutrition
Fewer GU Infections during Pregnancy
Improved Mental Health during Pregnancy/Postpartum
Fewer LBW and VLBW Births
Fewer Premature Births
Lower Fetal and Infant Mortality
Social Agency Referral for Other Factors
PPOR Findings
Improved Women’s Health
Mapping revealed addressing Maternal Health
was vital to reducing the poor birth outcomes
experienced in Pinellas County
Maternal Maternal Health/ Health/
PrematuritPrematurityy
Preconceptional Health
Healthy Behaviors
Perinatal Care Before Pregnancy
4 Opportunities
Healthy Healthy Start Home Start Home
VisitingVisiting
Screening Screening Tool for Tool for WomenWomen
Linkage to Linkage to Existing Existing Health Health
ProgramsPrograms
Community Community Health Health
EducationEducation
Pre/Interconceptional Current and Future
Activities
1-on-1 Education
Chronic Disease and Obesity Prevention Programs
“What About Mom”
“Beauty Talk”
Women’s Health Questionnaire
“While You Wait”
Part 2:
Integrating Interconceptional Education and Counseling into Healthy
Start: A+ Best Practice
Pinellas County Home Visiting Program for Pregnant Women and Infants
Why develop another Healthy Start Enhanced
Service? More than 50% of pregnancies are unplanned.
Untreated/Unmanaged Chronic Health conditions prior to pregnancy may increase risk of poor birth outcomes.
Healthy Start participants need correct information about their personal health.
Including Interconceptional Education and Counseling in
Pinellas County
Primary Goals X 2Ensure Annual Well-Woman
VisitAchieve Baby Spacing
• Interconceptional Care is what we know as “Women’s Health” which includes family planning, healthy
lifestyles, and medical care of any health problems.
Interconceptional Care
Interconceptional Education and Counseling
1. Assesses the women’s current health status using a
Women’s Health Questionnaire.
Interconceptional Education and Counseling
2. provides activities that educate and inform the
Healthy Start woman about specific topics related to
Women’s Health.
Interconceptional Education and CounselingTopics
Environmental risk factors
Stress & Mental Health
Substance use/smoking
Chronic Health Problems
Physical ActivityNutrition
Baby spacingMaternal Infection
Access to Health careWomen’s Health
10 Brochures to prompt
discussions in each risk factor
topic area.
Interconceptional Education and Counseling
3. Uses a Risk Reduction Approach.
Risk Reduction Approach Frequent and routine
assessment of progress is made during home visiting.
Care Coordinator/Home Visitor
• Focus on linking mother to an on-going medical home.
• Heavy emphasis on baby spacing and step by step risk reduction.
Health Statistics
Facts about Women’s Health
Leading Causes of DeathPinellas County 2002
Heart Disease 3,345 Pneumonia/Influenza 254Cancer 2,683 Liver Disease 132Stroke 728 SIDS/HIV 65Emphysema 739 Suicide 154Accidents 423 Homicide 59Diabetes Mellitus 296
Routine Health Maintenance and Family Planning for Women• Health status screening and physical activity
• Physical exam, including STD screening
• Dietary/nutritional assessment
• Screening for tobacco, alcohol and other
drugs
• Screening for domestic violence
Documentation in Healthy Start Records
Establish separate record for
woman and baby.
MEASUREABLE RESULTS
New Encounter Code 8013
Information Given
Referral Made
Services Received
Low Birthweight accounts for 10 percent of all health care costs for children.
Hospital stays for newborns typically averaged $4,300 in 2001. For LBW, the costs were $58,000.
Cost Saving
s
Promotion of women’s health needs should be a collaborative approach within the medical community and community-at-large.
What else is there to know?
Statewide agency support was gained through the efforts of Florida’s Perinatal Periods of Risk Practice Collaborative model.A new chapter has been added to the HS Standards and Guidelines.
What barriers might be experienced?
Women are concerned less for themselves when the baby is born and often forget to pay attention to their own needs. Interconceptional education and counseling is an opportunity to focus on the health needs of the entire family.
Remaining Advice?
