Increasing Breastfeeding in Primary Care

Transcription

1 Increasing Breastfeeding in Primary Care Sarah A. Tice, PHN, IBCLC Program Coordinator of Comprehensive Cancer Grant Schenectady County Public Health Services January 23, 2014

2 Presentation Topics Breastfeeding friendly overview Working with healthcare providers Policy Development and Implementation Resources 2

3 What does a Breastfeeding Friendly Practice look like? Most providers would say they are breastfeeding friendly. What actually constitutes being breastfeeding friendly? 3

4 10 Steps to a Breastfeeding Friendly Practice 1) Develop and maintain a breastfeeding-friendly office policy. Assessment of BF friendly readiness Where are they now? Where would they like to be? 2) Train all staff to be breastfeeding-friendly by promoting, supporting, and protecting breastfeeding. Ongoing training necessary. Disability awareness & breastfeeding 4

5 10 Steps to a Breastfeeding Friendly Practice 3) Eliminate all infant formula and formula company materials from your office. Decreased breastfeeding exclusivity due to formula supplementation Inconsistent messages about breastfeeding due to distribution of free formula and promotional materials 4) Create a breastfeeding-friendly office environment. What is found in the waiting rooms & patient areas? 5

6 10 Steps to a Breastfeeding Friendly Practice 5) Discuss the benefits of breastfeeding, especially exclusive breastfeeding, and the basics of breastfeeding management with women and their families during the prenatal period. Key consistent breastfeeding messages. Benefits of breastfeeding despite disability. 6) Discuss the benefits of breastfeeding, especially exclusive breastfeeding, and the basics of breastfeeding management with women and their families during the postpartum period. Normal expectations when breastfeeding. Assistive devices used when necessary. 6

7 10 Steps to a Breastfeeding Friendly Practice 7) Encourage breastfeeding mothers to feed newborns only breast milk. Exclusive breastfeeding for the first 6 months of life with continued breastfeeding as long as mutually desired by the mother and baby. 8) Teach mothers about maintaining lactation when separated from their infants. Breast pumps are a covered benefit! 7

8 10 Steps to a Breastfeeding Friendly Practice 9) Identify your local breastfeeding support network and foster collaborative working relationships and referral systems. Maintain a current list of community resources. 10) Provide comprehensive breastfeeding support to new mothers. Develop a triage system to prioritize breastfeeding problems or promptly refer to professional lactation counseling. 8

9 Why target providers? Multiple studies have shown how provider encouragement is crucial to mothers choosing to breastfeed. Lu et. al. (2001) found that: Women who were encouraged to breast-feed were more than four times as likely to initiate breast-feeding as women who did not receive encouragement. In populations traditionally less likely to breast-feed, provider encouragement significantly increased breast-feeding initiation, by more than threefold among low-income, young, and lesseducated women; by nearly fivefold among black women; and by nearly 11-fold among single women. 9 Lu MC., Lange L., Slusser W., Hamilton J., Halfon N Provider encouragement of breast-feeding: evidence from a national survey. Obstet Gynecol. 97(2):

10 How can you assess practices for breastfeeding friendly readiness? 10

11 Assessment Visual Formula advertisements Artwork Magazines Pens Clipboards What would a mother see upon entering a practice? 11

12 Assessment Office Environment Staff attitude (gauge interest) Community resources Educational materials Private place to breastfeed or pump that is wheelchair accessible Does the office appear supportive of breastfeeding? 12

13 Academic Detailing Getting buy-in from providers Reaching out to practices Getting an appointment Asking where they could use assistance? Key: Prioritizing information Practices are time constrained! What is most important for them to know? 13

14 Training Specific to: Practice Providers Based on knowledge/experience Nurses Ancillary Staff Different positions require different training. 14

15 Office Champion Key to sustainability! Who will continue teaching in the future? Train the Trainer Awareness of breastfeeding needs for women with disabilities Encourage continued lactation training for that Champion 15

16 Provider Educational Resources Well-start International. Lactation Management Self-Study Modules American Academy of Pediatrics. Health Professionals Resource Guide. Breastfeeding Friendly Consortium Training Course Center for Public Health Continuing Education Provider CME 16 Expanding Pediatricians' Roles in Breastfeeding Support: Continuing Medical Education (CME) Online Tutorial

17 What should providers be trained on? 17

18 Barriers for moms Addressing barriers for moms Perceived incapability to adequately nourish their child Maintaining BF when they are away from infant Reentering the workplace or school Ability to breastfeed wherever they are Social norms 18

19 Importance of support Educating family members (especially those closest to mom) Lack of breastfeeding in past generations Breastfeeding role models? Sexual connotation Social norms 19

20 Addressing Culture Environmental Culture Stigma for breastfeeding in public Social norms Breastfeeding desert- local community support within walking distance Ethnic Culture Acceptability within respective culture Weaning times Social norms 20

21 Understanding values Why do they want to breastfeed? Keeping the baby healthy? Increase IQ? Lower risk of SIDS? Keep mom healthy? Bonding? Urge to lose baby weight? Cost? What does it mean to them? 21

22 How can providers get reimbursed for breastfeeding services? 22

23 Reimbursement Coding for Breastfeeding (see pocket guide) Breast pumps covered benefit through Medicaid Manual Breast pump (E0602) $31.71 max Electric Breast pump (E0603) $ max Hospital Grade Breast pump (E0604) $38.61 per month max Only available for certain circumstances 23

24 Lactation Counseling Codes A provider who employs an IBCLC may bill Medicaid for lactation counseling. S9445 Individual Includes initial counseling session (45 minutes minimum) and follow-up sessions (30 minutes minimum). S9446 Group One prenatal and one post-partum class (60 minute minimum per class) per pregnancy. 24

25 WIC Community Resources La Leche League NYSDOH Breastfeeding Promotion Program ng/ National Breastfeeding Helpline (English & Spanish) 25

26 Additional Resources

27 What are the first steps towards developing a Breastfeeding Friendly office policy? 27

28 Policy Development Practice specific policy from the 10 steps to become Breastfeeding friendly Pediatric, OB/GYN, family practice Things to consider Policy already in place? Specific areas to target? Feasibility? 28

29 Policy Implementation GRADUAL! Complete overhaul all at once is not realistic. Could lose buy-in. Evaluation tool What s the goal? Technical support 29

30 Conclusion Engaging primary care providers is essential to the initiation and continuation of breastfeeding. Current evidence based training is necessary for all staff to create a breastfeeding friendly atmosphere. Variety of resources are available and are key to sustainability. Breastfeeding reimbursement is available for services. 30

31 Contact Information Sarah A. Tice, PHN, IBCLC