“ Stir-Fried” Strategies for Women’s Health

1. “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

2. Part 1:Utilizing PPOR Results to Develop Strategic Interventions Pinellas County PPOR analysis conducted during 1998-2000.

3. Local Results. . .

4. Maternal Health & Prematurity 136 deaths 4.7 Maternal Care 68 deaths 2.3 Newborn Care 41 deaths 1.4 Infant Care 46 deaths 1.6 Feto-Infant MortalityAll Births, Pinellas County, 1998-00 291 Feto-Infant Deaths 29,085 Fetal Deaths & Live Births Overall Rate: 10.0

5. Maternal Health & Prematurity 46 deaths 10.1 Maternal Care 14 deaths 3.1 Newborn Care 6 deaths 1.3 Infant Care 16 deaths 3.5 Feto-Infant MortalityBlack Race, Pinellas County, 1998-00 82 Feto-Infant Deaths 4,569 Fetal Deaths & Live Births Overall Rate: 17.9

6. Excess Feto-Infant MortalityPinellas County 1998-00 Florida DOH Reference Excess All Races 2.4 4.7 2.3 1.6 0.9 1.0 0.7 0.5 0.6 2.3 1.4 1.6 _ = 10.0 5.8 4.2

7. Phase 2 Analysis Findings • Kitagawa: Over HALF of excess feto-infant mortality is due to the LARGE NUMBER of VLBW births • Examples of risk factors examined:

8. Leading Prevention Strategy • Provide preconceptional and interconceptional care to women of reproductive age

9. Program Map Input Activities Outputs Results Physician Referral for High Score Care Coordination Improved Access to Healthcare for WCBA Fewer LBW and VLBW Births Interconceptional Care Early Entry into Prenatal Care Fewer Premature Births Physician Referral for Other Factors Community Consortium Building Repeat Births at Least 2 years after Last Lower Fetal and Infant Mortality Family Planning Social Agency Referral for Other Factors Fewer Women Smokers Improved Women’s Health Identify stress and mental health issues Improved Maternal Nutrition Outreach Education on Women’s Health Issues Fewer GU Infections during Pregnancy Pregnancy Testing Counseling/Referrals Improved Mental Health during Pregnancy/Postpartum Self Referral Peer Support Groups PPOR Findings Targeted Outreach

10. Mapping revealed addressingMaternal Health was vital to reducing the poor birth outcomes experienced in Pinellas County Preconceptional Health Healthy Behaviors Perinatal Care Before Pregnancy Maternal Health/ Prematurity

11. 4 Opportunities Screening Tool for Women Healthy Start Home Visiting Linkage to Existing Health Programs Community Health Education

12. Pre/Interconceptional Current and Future Activities 1-on-1 Education Chronic Disease and Obesity Prevention Programs

13. “What About Mom” “Beauty Talk”

14. Women’s Health Questionnaire “While You Wait”

15. Part 2:Integrating Interconceptional Education and Counseling into Healthy Start: A+ Best Practice Pinellas County Home Visiting Program for Pregnant Women and Infants

16. 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.

17. Including Interconceptional Education and Counseling in Pinellas County Primary Goals X 2 Ensure Annual Well-Woman Visit Achieve Baby Spacing

18. Interconceptional Care • Interconceptional Care is what we know as “Women’s Health” which includes family planning, healthy lifestyles, and medical care of any health problems.

19. Interconceptional Education and Counseling1. Assesses the woman’s current health status using Women’s Health Questionnaire. 2. Provides activities that educate and inform the Healthy Start woman about specific topics related to Women’s Health.3. Uses a Risk Reduction Approach

20. Women’s Health Access to Health care Maternal Infection Baby spacing Nutrition Physical Activity Chronic Health Problems Substance use/smoking Stress & Mental Health Environmental risk factors Interconceptional Education and CounselingTopics

21. 10 Brochures to prompt discussions in each risk factor topic area.

22. Health Statistics Leading Causes of Death Pinellas County 2002 Heart Disease3,345Pneumonia/Influenza254 Cancer 2,683Liver Disease132 Stroke728SIDS/HIV65 Emphysema739Suicide154 Accidents423 Homicide 59 Diabetes Mellitus296 Facts about Women’s Health

23. 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 abuse and neglect

24. Diabetes High blood pressure Cardiac Disease Thyroid Disorders Epilepsy Asthma HIV Infection Systemic Lupus Thromboembolic Disease (clotting) Renal Disease Hemoglobinopathies (Sickle Cell) Cancers STD’s and Bacterial Vaginosis Screening for Medical Conditions

25. Screening forMaternal Infections • STDs (gonorrhea, syphilis and Chlamydia) • HIV • Hepatitis • Bacterial Vaginosis • Safe sex knowledge and practice (condoms) • Dental Access and Utilization • Screening for Periodontal Disease

26. Teratogens/Genetics • Self or prior child with congenital defect • Family history of genetic disease • Refer to geneticist for recurrence risk counseling and/or prenatal testing

27. Substance Use • Patient education as to effects of substances on fetus • Risk screening and assessment • Referral for treatment program • Pregnancy may be a strong motivator for change

28. Smoking • Effects of smoking effects on birth outcomes- preterm and low birthweight • Smoking in the household is associated with SIDS, childhood respiratory illness, asthma, and otitis media • Risk screening and assessment • Referral for smoking cessation

29. Domestic Violence • DV screening • Provide education: Two million women each year are abused by a partner • Referral and assistance

30. Nutrition • Assessment by weight/height and BMI • Education about risk - Underweight (BMI < 18.5 pre pregnancy) - Overweight (BMI 25-29.9) - Obese (BMI 30 or greater) • Nutrition counseling and referral

31. Physical Activity • Daily and Weekly Physical Activity

32. Prevention of Neural Tube Defects folic acid for all women of childbearing potential

34. Documentation in Healthy Start Records Establish separate record for woman and baby.

35. MEASUREABLE RESULTS • New Encounter Code 8013 • Information Given • Referral Made • Services Received

36. 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?

37. 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?

38. 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?

39. jane_bambace@doh.state.fl.usjennifer_opalek@doh.state.fl.us Additional Information