1. CENTERINGPREGNANCY PROGRAM IMPROVING ACCESS AND OUTCOMES IN THE SOUTHWEST HEALTH DISTRICT
2. DISTRICT AND CENTERING CATCHMENT AREA W are Burke C linc h H all Laurens Early Lee Bulloch Floyd W ayne C harlton Fulton Long C offee W orth Em anuel Polk Screv en D odge Troup C arroll D ecatur C am den Bryan Gr ady H arris D ooly C obb Gly nn Brooks W ilk es C olquitt Liber ty Thom as Appling Gilm er Jones Bartow R abun Irw in Sum ter Echols Fannin Tift C ow eta Telfair W alk er U nion M acon M itchell Tay lor Low ndes Elbert Tattna ll Berrien W ashington Talbot Bibb H ancock Baker Gr eene Jasper Stew art M onroe U pson W ilc ox C risp Pierce Pike Brantley M arion H enry Jefferso n H art Tw iggs C lay Gor don Gw inn ett Putnam M urray H eard C ook M iller Toom bs R andolph Bacon M organ Terr ell Effingham W alton W ilk inson Jenkins M cIntosh C herokee H ouston C hatham M eriwether Jacks on Turner Banks Paulding Oglethorpe Atkinson Johnson W hite Pulaski C alhoun Baldw in W arren Linc oln N ew to n Lum pkin R ichm ond M adison W heeler C raw ford C olum bia D e K alb Butts C andler Frank lin Evans H aralson D ougherty Lam ar Lanier C hattooga Pickens Ben H ill Fors yth Jeff D avis Tow ns W hitfield D aw son Seminole D ouglas Bleckley Oc onee Schley Habersham Fay ette Barrow Spalding C atoos a Treutlen M usc ogee Mont- gomery Taliaferro Quitm an Glas cock Chatta-hoochee Clayton Rockdale Ste p hens McDuffie Clark e Pea ch W ebste r Dad e 8-1 9-2 7 5-1 9-3 5-2 6 10 2 1-2 1-1 3-1 4 3-4 3-2 3-5 9-1 3-3 8-2 Georgia Public H ealth D istricts 1-1 N o rth w e st (Ro m e) 1-2 N o rth G A (D a lto n ) 2 N o rth (Ga in esville) 3-1 C o bb -Do u g la s 3-2 F u lto n 3-3 C la yto n 3-4 E a st M et ro 3-5 D e Ka lb 4 L a Gra n g e 5-1 S o u th C en tr al (Du b lin ) 5-2 N o rth C e nt ral (M a c o n ) 6 E a st C e n tra l (A u g usta ) 7 W e st C e ntr al (C olu m b u s) 8-1 S o u th (V a ld o sta ) 8-2 S o u thw e st (Alb an y) 9-1 C o asta l (Sa va n n ah ) 9-2 S o u the a st (W a yc ro ss) 1 0 N o rth ea st (A th e ns)
3. Problem Being Addressed Barriers to early access to prenatal care for low-income women African-American women 14 county predominantly rural district, many counties no obstetrician Loss of three high-volume OB/GYN Medicaid providers in Dougherty, 2008 Dougherty County: 64% African-American Dougherty County accounts for a third of the districts population Presumptive eligibility for pregnancy Medicaid not accepted by most obstetricians in Dougherty County Hispanic women The Districts southernmost counties are agricultural hubs Colquitt Countys Hispanic population estimated at 14% - probably significantly under-estimated due to a large number of undocumented Hispanic farm workers Transportation issues June, 2010 prenatal care for undocumented low-income Hispanic no longer financed by the Babies Born Healthy (BBH) Program
4. What Is Centering? National model of group prenatal care Groups of 6-8 women whose due dates are in the same month Nine two-hour sessions Individual assessments Facilitated discussions Sessions are fun and interactive Time for socializing and refreshments Sessions are held at the same intervals as traditional prenatal care Monthly until 28 weeks gestation Every two weeks until 36 weeks gestation
5. What Is Centering? Support people involved in sessions Social Worker co-facilitates sessions More experience with depression, domestic violence and other social issues More likely to pick up on non-verbal cues related to some of these issues Patients participate in their prenatal care Take their own blood pressure Weigh themselves Plot and monitor their weight Wheel out their gestational age
6. Maternal Characteristics: Medical Dougherty County Health Department Slightly less than 3% had a prior preterm birth 30% were treated for sexually transmitted infections 18% reported tobacco use and 15% tested positive for marijuana Slightly more than a third were anemic 18% were treated for asymptomatic bacteriuria 5.5% reported depression 4.5% had sickle cell trait 6% developed gestational diabetes
7. Maternal Characteristics: Medical Ellenton Clinic 12% treated for sexually transmitted infections None reported tobacco use or tested positive for marijuana None reported a history of asthma Over half were anemic 16% developed gestational diabetes 4% reported depression
13. Low Birth Weight Rates 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 5.3% 6.8% 8.4% 11.8% 15.7% Ellenton Centering District Hispanic District NH Whites Do Co Centering District NH Blacks
14. Breastfeeding Initiation Rates Dougherty Centering Dougherty WIC-FY 2014 75% 25% Breast feeding Formula 51% 49% Breast feeding Formula
15. Breastfeeding Initiation Rates Ellenton Centering Colquitt WIC-FY 2014 75% 25% Breast feeding Formula 65% 35% Breast feeding Formula
16. CenteringPregnancy: Expanding Services Through the Use of Telemedicine * Better coordination of services * Easier access to subspecialists: Maternal Fetal Medicine Cardiologist Mental and Behavioral Health Dermatologist
17. Access to telemedicine allows ultrasounds and Maternal Fetal Medicine consults to be done on-site
18. Through a partnership with Womens Telehealth in Atlanta, Dr. Anne Patterson is introduced to each Centering group and included in facilitated discussions in sessions on pre-term labor and gestational diabetes via the telemedicine cart.
19. Southwest Health District CenteringPregnancy Program: A patient-centered model for prenatal care that is expanding access to comprehensive care and is making a difference!