“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

291Feto-Infant

Deaths

29,085Fetal Deaths

& Live Births

Maternal Health & Prematurity136 deaths

4.7Maternal 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

82Feto-Infant

Deaths

4,569Fetal Deaths

& Live Births

Maternal Health & Prematurity46 deaths

10.1Maternal 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

AnemiaChr. HypertensionSmokingAlcohol/Drugs3rd Trimester PNCNo PNC

•Risk Factors Examined included:Risk Factors Examined included:

From Prenatal Screen

AppointmentsMovedUnsafeHungryHigh StressUnwanted Pregnancy

Leading Prevention Strategy

• Provide preconceptional and interconceptional care to women of reproductive age

Program MapInpu

tActiviti

esOutput

sPhysician 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 HealthHealthy BehaviorsPerinatal 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 StatisticsFacts 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?

jane_bambace@doh.state.fl.us

jennifer_opalek@doh.state.fl.us

Additional Information