Integrating Preconception and Primary care: Evaluation of a Preconception Toolkit

Project Number: R40 MC 11280-01
Project Date: 2/1/2009
Grantee: Emory University School of Medicine
Department/Center: Department of Family and Preventive Medicine

Final Report

Pending

Principal Investigator

Anne L. Dunlop MD, MPH,
Assistant Professor, Emory University School of Medicine Department of Family and Preventive Medicine,
1256 Briarcliff Road
Atlanta, Georgia  30322
amlang@emory.edu

Abstract

In recent decades, improvements in pregnancy outcomes for mothers and infants have slowed or deteriorated and racial disparities have widened. Evidence supports that further improvements in maternal and child health outcomes, and amelioration of racial disparities, requires strategies to reduce unplanned pregnancies and improve women’s health prior to conception. To this end, the Centers for Disease Control and Prevention (CDC) has released evidence-based clinical recommendations for improving preconception health and health care. The CDC, along with several other professional organizations, also specifically call for the integration of these evidence-based preconception care practices into women’s primary health care and for the development and evaluation of tools to promote such integration. Despite the evidence supporting the importance of specific preconception health care strategies, only about one in four primary care providers deliver preconception health care. Furthermore, data demonstrate that low-income and minority women, who are at higher risk for unintended pregnancies and adverse pregnancy outcomes, are the least likely to receive preventive and preconception health care services. The long-term goal of this work is to promote women’s receipt of family planning and preconception health services as part of their primary health care in order to reduce the proportion of pregnancies that are unintended and unplanned and the proportion of women who enter pregnancy with modifiable medical and behavioral risks for adverse outcomes. Specific aims of this study include: (1) to implement a Preconception Care Toolkit, based upon existing evidence-based recommendations, in publicly-funded primary care clinics that primarily serve low-income, minority women; (2) to conduct an outcome evaluation of the implementation of the Preconception Care Toolkit to assess its effect on provider practices and patient outcomes; and (3) to conduct a translatability evaluation of the implementation of the Preconception Care Toolkit to evaluate the potential for translation of the bundle of evidence based preconception care strategies contained within the Preconception Care Toolkit into the primary care setting. This evaluation project will take place in publicly-funded primary care clinics that provide services to low-income, minority (African-American and Hispanic) women at-risk for unintended pregnancies and adverse pregnancy outcomes. The outcome evaluation will involve two design elements: provider practices will be evaluated using a pre-intervention, postintervention design, whereas patient outcomes will be evaluated using a quasi-experimental cohort design with a non-equivalent, no-treatment comparison group. We will employ the REAIM framework to consider the intervention’s reach, effectiveness, adoption, implementation, and maintenance at the level of the providers and patients.

Publications

Pending

Keywords

African Americans, Community Based Health Services, Comprehensive Primary Care, Family Planning, Health Promotion, Hispanics, MCH Research, Preconception Care