Delivering Interconception Care During Well-Child Visits: An IMPLICIT Network Study.

Autor:	Srinivasan S; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR). srinivasans@upmc.edu., Schlar L; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR)., Rosener SE; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR)., Frayne DJ; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR)., Hartman SG; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR)., Horst MA; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR)., Brubach JL; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR)., Ratcliffe S; From the University of Pittsburgh Medical Center (UPMC) St. Margaret Family Medicine Residency, Pittsburgh, PA (SS); UPMC Shadyside Family Medicine Residency, Pittsburgh (LS); Middlesex Hospital Family Medicine Residency Program, Middletown, CT (SER); MAHEC Family Health Centers, Asheville, NC (DJF); Department of Family Medicine, University of Rochester, Rochester, NY (SGH); Lancaster General Research Institute, Lancaster, PA (MAH); IMPLICIT Network and UPMC McKeesport, Shadyside and St. Margaret Family Health Centers, Pittsburgh (JLB); Lancaster General Family Medicine Residency, Lancaster (SR).
Jazyk:	angličtina
Zdroj:	Journal of the American Board of Family Medicine : JABFM [J Am Board Fam Med] 2018 Mar-Apr; Vol. 31 (2), pp. 201-210.
DOI:	10.3122/jabfm.2018.02.170227
Abstrakt:	Background: Preterm birth, birth defects, and unintended pregnancy are major sources of infant and maternal morbidity, mortality, and associated resource use in American health care. Interconception Care (ICC) is recommended as a strategy to improve birth outcomes by modifying maternal risks between pregnancies, but no established model currently exists. The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network developed and implemented a unique approach to ICC by assessing mothers during their baby's well-child visits (WCVs) up to 24 months. Methods: Mothers who accompanied their children to WCVs at eleven eastern US family medicine residency programs underwent screening for four risk factors (tobacco use, depression risk, contraception use to avoid unintended pregnancy and prolong interpregnancy interval, and use of a multivitamin with folic acid). Positive screens in women were addressed through brief interventions or referrals to treatment. Results: Mothers accompanied their babies to 92.7% of WCVs. At more than half of WCVs (69.1%), mothers were screened for presence of ICC behavioral risks, although significant practice variation existed. Risk factors were identified at significant rates (tobacco use, 16.2%; depression risk, 8.1%; lack of contraception use, 28.2%; lack of multivitamin use, 45.4%). Women screened positive for 1 or more ICC risk factor at 64.6% of WCVs. Rates of documented interventions for women who screened positive were also substantial (tobacco use, 80.0%; depression risk, 92.8%; lack of contraception use, 76.0%; lack of multivitamin use, 58.2%). Conclusion: WCVs provide a reliable point of contact with mothers and a unique opportunity to assess and address behavioral risks for future poor birth outcomes. Competing Interests: Conflict of interest: none declared. (© Copyright 2018 by the American Board of Family Medicine.)
Databáze:	MEDLINE
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