Powell River IPCC Connecting Pregnancy

Feasibility Pilot 2011-2013

Evaluation Summary

The Team • The Powell River Connecting Pregnancy Pilot program team

consisted of: • • Dr. Susan Horsfall, GP • Dr. Danielle Marentette, GP • Margaret Antolovich, VCH Public Health • Patti Diplock, VCH Public Health • Tanja Hanson, VCH Public Health • Yogeeta Dosanjh, VCH-PR IPCC Community Change Lead • Laurie Ringaert, VCH Manager of IPCC Evaluation • Danielle Simpson, VCH-IPCC Community Evaluator

The Goal • The Pilot was designed

to assess the feasibility of providing a rural model of interdisciplinary primary maternity care in a group setting.

Objectives • 1: To pilot a Rural Integrated Perinatal Health model of care based

on an adaptation of the “Connecting Pregnancy” model to improve continuity of care and health outcomes for mothers and babies in Powell River.

• 2: To bring pregnancy and birth back to a community-based, peer-supported, primary care experience that is culturally-appropriate and woman-centered during pregnancy, birth and the newborn period.

• 3: To determine, (from the providers point of view), if providing

primary prenatal care in a group setting vs the traditional individual clinic model had any advantages in terms of efficiency, satisfaction, and long term sustainability.

•

Origins • Adapted from the “Connecting Pregnancy”

model used at the South Community Birth Program & the Family Practice Maternity Service at BC Women’s Hospital in Vancouver

• Which was in turn adapted from the Centering Pregnancy Program developed by the Centering Health Institute.

One of Many Powell River IPCC Initiatives

The Pilot program is one of the many initiatives of the Powell River IPCC Steering Committee. IPCC (Integrated Primary and Community Care) is a provincial initiative aimed at: • Integrating physicians, health

authority and community staff and programs in order to: Provide more coordinated,

effective and efficient care that results in

Better patient, provider experiences as well as better patient outcomes and greater cost effectiveness for the system

About Our Community • Population 20,000 • Approximately 140

deliveries/year • 38 resident doctors (1 Obstetrician, 7 GPs doing

deliveries) • Located 145 km north of

Vancouver on the Sunshine Coast

• Access by ferries or by air from Vancouver or by ferry from Vancouver Island (Comox)

Powell River

Vancouver

Partnership Between Physicians and VCH Public Health

• Co-facilitated by 2 Family Physicians and a Public Health Nurse

• Family Physicians provided group education, belly checks, overall individual perinatal care

• Public health nurse provided group support, education, and also arranged for guest speakers such as a Dietitian, Mental Health Clinician, Doulas, and an Infant Development Consultant.

• Public Health nurse followed with

individual post natal home visits

The woman’s prenatal care was completely taken care of by the Connecting Pregnancy general practitioners for the duration of her pregnancy in order to provide continuity of care.

The program incorporates assessment, support, and education, and alters routine prenatal care by bringing women out of exam rooms and into groups for their care.

The Participants & The Program

• 24 enrolled • 21 completed the

program • 3 series provided • 8-9 sessions in each

series • Variety of presenters • Follow-up provided by

physicians and nurse

Evaluation Methods

• Post-session in class questionnaire • Participant focus group • Key informant interviews with Providers • Analysis & Synthesis including extensive

feedback, co-analysis work with team

How Prepared for Labour and Delivery did you feel?

96.9% of

participants rated themselves as either feeling 4 or 5 on a scale of 1 to 5, with 5 being “well prepared”.

0.0% 0.0%

8.3%

33.3%

63.6%

0%

10%

20%

30%

40%

50%

60%

70%

Not Prepared WellPrepared

How prepared for your labour and delivery did you/do you feel?

Excellent Breast Feeding Outcomes

A key outcome of this program was that 86% of the

women were still breastfeeding at

6 months

Providers’ Perceptions (Physicians & Public Health Nurses)

• Providers felt that women experienced

• better birth experience • fewer breast feeding

issues • fewer mood issues in the

post-partum period • were surprised how well

connected many of the moms still remained

More Satisfied Physicians • The physicians described

that this program enhanced their own practice

• Made it more time efficient:

creating more availability for other patients

• Made them feel more satisfied with their clinical practice

• Reduced duplication and repetition

Voice of Providers “The labour experience of some moms was

amazing as they were confident and empowered.”

“The simple statement from the participant evaluation that ‘I plan to breastfeed as long

as I can’ is very powerful.”

Voice of a Mom

“The connection with others was important.

I was going through a lot after the birth & talking/connecting with these women/families helped me not feel alone and like I had a community”

Continuity was Key • “I found the co-facilitators great. They were

excellent, enthusiastic, and approachable. [The Public Health Nurse ] stayed and listened even after the session. When we needed information after the sessions, I could always call [her].

• After giving birth, it was nice to have her come visit me at home. She didn’t forget about me – this was important. My health was important to her.”

Continuity was Key “It was somehow reassuring to hear a nurse's

voice I knew and comfortable with checking in on me and baby”

More Key Outcomes for Moms & Families

• A key benefit appears to be the mixing of moms of various ages, socio-economic risk and thus providing peer support and mentoring

• Moms liked meeting other moms, learning new information & being able to ask questions in a “safe” environment

• Moms stayed connected after the births/program

More Key Outcomes for Moms & Families

• Dad’s & other family who participated also found it beneficial

• All liked learning about access to available community resources for perinatal parents

More Key Provider Outcomes • All providers said they

learned a great deal from each other, from speakers and enhanced their own practices

• Providers were impressed with how many of the moms stayed connected long after the births

• Improved cooperation and communication between health care providers

This Pilot Shows that Integration Works!

• Integrating the physicians and the health authority staff resulted in better coordination and efficiencies & better understandings of each others services

• It also resulted in positive experiences expressed by the providers and the patients

• Moving toward the Triple Aim!

Key Challenges • Logistics (time of day,

room, transportation, privacy)

• Need for expansion to include other patients and physicians

• Evaluation Limitations

We Have Already Made Changes!

• New Group Meeting Space

• Physician meeting January 2014

• More Physicians indicate interest in participating

• Revisions to Mother’s Handbook

• Revising PHN delivered prenatal classes

What’s Next?

• Securing VCH resources (Public Health) • Smoothed out logistics • Discussing expansion of the program to more

women and physicians in the community • Expanding the evaluation to follow more

outcomes over time.

Please Contact Us!

Margaret Antolovich, RN, BScN, M.ED Manager Public Health and Prevention Services Powell River/Sunshine Coast/Coastal HSDA

Vancouver Coastal Health Phone: 1 (604) 485-3330 Fax: (604) 485-3305 margaret.antolovich@vch.ca