Well-child visits provided a “unique opportunity” and “reliable point of contact” for primary care physicians to evaluate and discuss maternal health risks that could lead to poor birth outcomes in the future, according to findings recently published in the Journal of the American Board of Family Medicine.
“The need to develop and validate new models of care to deliver preconception and interconception care to women is very important. Delivering care during these time periods is crucial for changing behavior and improving birth outcomes and is endorsed by many national stakeholders,” Sukanya Srinivasan, MD, MPH, of the family medicine residency program at the University of Pittsburgh Medical Center, told Healio Family Medicine.
“By the time women enter prenatal care, it often is too late to influence birth outcomes, but [our] model allows modifiable risk factors to be addressed prior to pregnancy, regardless of whether women are seeking care for themselves or for their child,” she added in a press release.
Researchers created The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques, or IMPLICIT Network, in approximately two dozen sites in the eastern United States and medically evaluates mothers during their baby's well-child visits up to 24 months. Data from 5,927 women and 17,630 well-child visits were analyzed.
Srinivasan and colleagues found that at 69.1% of the visits at all the sites, mothers were screened for the presence of intercontraception behavioral risks, but they also found significant practice variation. Risk factors were identified at significant rates: lack of multivitamin utilization, 45.4%; lack of contraception utilization, 28.2%; tobacco use, 16.2%; and risk for depression, 8.1%. Women screened positive for one or more these risk factors at 64.6% of the visits.
In addition, recorded intervention rates for women who screened positive were also substantial: risk for depression, 92.8%; tobacco use, 80%; lack of contraception utilization, 76%; and lack of multivitamin utilization, 58.2%.
According to Srinivasan, even PCPs not in the IMPLICIT Network can usually utilize the program.
“This innovative, easy-to-incorporate approach can be applied in any primary care setting where mothers and babies are seen together PCPs can also use a toolkit the IMPLICIT Network recently developed with the March of Dimes — available at www.prematurityprevention.org — which contains the necessary background, evidence and resources for any interested provider to successfully implement the IMPLICIT model in the context of well-child visits.”
“However, implementation at a site is encouraged only if the site has intervention strategies in place to address positive screens,” she added.
The authors report no relevant financial disclosures.