Pennsylvania s EPIC B.E.S.T. Initiative Educating Physicians In their Community Breastfeeding Education Support & Training 1
Pennsylvania Initiation by County Mercer 59.8 Lawrence 54.2 Beaver 56.3 Erie 61.6 Crawford 69.2 Washington 55.9 Greene 50.2 Butler 72.8 Allegheny 61.9 Venango 52.8 Fayette 41.9 Clarion 60.6 Armstrong 54.7 Warren 68.7 Westmoreland 59.4 Forest 52.8 Jefferson 65.1 Indiana 67.7 Somerset 68.5 McKean 53.0 Elk 50.9 Cambria 57.8 Clearfield 53.8 Blair 58.6 Cameron 52.0 Potter 64.5 Huntingdon 58.2 Centre 77.1 Clinton 67.1 Mifflin 60.7 Tioga 72.7 Juniata 75.6 Perry 69.2 Lycoming 69.4 Union 75.6 Snyder 76.2 Bradford 60.1 Sullivan 52.6 Columbia Montour 64.1 80.1 Northumberland 61.1 Dauphin 69.7 Cumberland 77.1 Bedford 63.1 Fulton Franklin York 60.1 74.1 Adams 71.6 66.2 Lebanon 72.3 Schuylkill 46.5 Lancaster 80.7 Susquehanna 50.0 Wyoming 60.1 Luzerne 46.8 Berks 68.3 Lackawanna 50.5 Wayne 58.1 Monroe 68.6 Carbon 55.9 Northampton 67.1 Lehigh 75.6 Chester 77.6 Bucks 71.2 Montgomery 79.1 Delaware 68.0 Pike 59.1 Philadelphia 51.2 Percent: Less than 50.0 50.0-62.9 63.0-74.9 75.0 & Above Certificate of live birth. Pennsylvania Department of Health, Bureau of Health Statistics and Research, 2006 2
Pennsylvania 67 counties (48 rural) 12.3 million people (6 th largest state in US) 145,000 births/year (50% WIC eligible) 3,600 out of hospital births/year (most in US) 10% African American (largest minority group) Birthing hospitals: (11 counties without) 124 in 2005 and by Oct 2008 down to 112 Rates of breastfeeding initiation among women who smoked during 3 rd trimester of pregnancy increased from 35.2% to 37.8% (2004 2006) 3
Local Coalition Members PA BF Coalition 501C Non-profit PABC Members Bureau of Health Promotion & Risk Reduction PA-AAP PA Medical Society Pennsylvania Breastfeeding Awareness and Support Division of Tobacco Prevention WIC USDA funding DOH BF Program Title V MCH Block Grant funding 4
PA EPIC B.E.S.T. Initiative 2009 Partners: PABC members DOH BF Program Sub-contractor PA-AAP Existing contract with Pennsylvania Medical Society 2008 PA-DOH, Bureau of Health Promotion and Risk Reduction, Division of Nutrition and Physical Activity Division of Tobacco Prevention and Control Program 2008 Unfunded Pennsylvania DOH, Division of Nutrition and Physical Activity grant application 2007 Budget cuts Pennsylvania DOH, Bureau of Family Health BF Program RFA Maternal Child Health Block Grant funds 5
Goal Improve the health and well being of Pennsylvania women and children by increasing the number of women who: Initiate breastfeeding Exclusively breastfeed for 6 months Continue breastfeeding for at least 1 year 6
Strategy Increase the number of health care professionals who promote breastfeeding by providing evidence based education, assistance, support and community referrals to women who are pregnant and/or interested in breastfeeding 7
Objectives At the conclusion of the presentation staff should be able to: 1.Describe the epidemiology of breastfeeding in the US 2.Implement an office policy to promote breastfeeding 3.Educate mothers who smoke about the importance of breastfeeding and tobacco cessation 4.Provide breastfeeding specific anticipatory guidance to support mothers to successfully breastfeed 5.Assist women with breastfeeding problems, challenges, and help them utilize community resources 8
3. Ten Steps to Support Parents Choice to Breastfeed Their Baby American Academy of Pediatrics, 1999, Rev. 2003 6. 7. 8. 9. 10. Expand the network of support for breastfeeding. Communicate support for breastfeeding in the office environment. Support breastfeeding by providing accurate information about maternal issues. Use appropriate anticipatory guidance that supports exclusive breastfeeding until infants are about 6 months old. Show mothers how to breastfeed and how to maintain lactation when they will be away from their babies. 5. Encourage mothers to breastfeed on demand. 4. Assess infants during early follow-up visits. Inform women and families about the benefits and management of breastfeeding. 2. Train all staff in skills necessary to support breastfeeding. 1. Make a commitment to the importance of breastfeeding. 9
Plan Conduct 50 trainings: In physician offices Pediatricians OB GYN Family Practice Grand Rounds at hospitals Professional staff education opportunities Publish Counter Details dedicated issue 10
Plan Develop a comprehensive curriculum for trainers Develop a resource manual for trainers and practices Research, select and purchase resources Secure CME and CEUs 11
Recruitment of Trainers SW and SE only Email blast and broadcast fax PA AAP E newsletter Word of mouth Flyers circulated Great response 10 Physicians from SW and 14 from SE 6 IBCLC from SW and 14 From SE 12
Recruitment of Practices SW and SE only Email blast and broadcast fax PA AAP E letter Posted on PA AAP front web page Direct mailing to 1,700 Word of mouth During education opportunities (Grand Rounds, staff education) 13
Initiation Conduct Train the Trainer sessions one each in SW and SE Trainings began Feb 12 Team of a Physician and IBCLC for each training
Creating an Office Breastfeeding Team What will it take to implement the ten steps into your practice?
Evaluation using the Re AIM Model Reach attracts target audience Expectation of meeting number of 50 trainings Expectation of one doctor and one IBCLC to cover each county as trainers Efficacy Exceeded our goal Short term focus evaluation Pre training evaluation tool Post training evaluation tool http://www.re-aim.org 16
Evaluation Adoptions Agree to make changes Assessing baseline of office at training scheduling call Speaking to physician or office manager Day of training Inviting office staff to consider change 2 week follow up call and assessment Review initial assessment What steps of changes the office is considering Motivational call http://www.re-aim.org
Evaluation Implementation 2 month follow up assessment Impact Level of change of breastfeeding support in office Maintenance 4 month assessment Comparing initial with 2 and 4 month assessment Considered our outcome measure http://www.re-aim.org 18
To Date Have completed/scheduled: 7 Hospital Grand Rounds 24 Pediatric offices 2 OB offices 2 Family Practice offices Counter Details (written but not published yet) Distribution: 21,000 providers (MDs, PAs, CNMs) 19
Faculty Primary Authors Debra Bogen MD, FAAP, FABM Penny Soppas MD, FAAP, IBCLC Esther Chung MD, FAAP, MPH Martha Kautz RNC, BS, IBCLC Dottie Schell, BS, RN, CBC, CTAS Iris Colón Buchette Contributors Serina Gaston, M.Ed, CHES Judith Gutowski, IBCLC Gail Herrine MD Kay Hoover, M.Ed, IBCLC Barbara Layne RN Jeanne Spencer MD, FAAFP Suzanne Yunghans 20