brandi cooke
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Factors Affecting the Willingness of Counselors to Integrate Preconception Care into Sexually Transmitted Disease Clinics. Brandi Cooke. Student Intern 3 rd National Summit on Preconception Health and Health Care June 12-14, 2011. - PowerPoint PPT PresentationTRANSCRIPT
Brandi CookeStudent Intern
3rd National Summit on Preconception Health and Health Care
June 12-14, 2011
Factors Affecting the Willingness of Counselors to Integrate Preconception Care into Sexually Transmitted Disease
Clinics
National Center on Birth Defects and Developmental DisabilitiesPlace Descriptor Here
Preconception Care Best time to identify and address risk factor
for reproductive health is before not after conception Not universally available Advancing as standard of care
• “Recommendations to Improve Preconception Health Care -- United States” (Johnson et al., 2006)
• “Policy and Financing Issues for Preconception and Interconception Health “ (Markus, 2008)
• “Preconception Health and Health Care: The Clinical Content of Preconception Care” (Jack & Atrash, 2008)
Preconception Care Challenges Major Challenges
Insufficient reimbursement for risk assessment and health promotion activities
Lack of clinical training programs emphasizing PCC risk assessment
Lack of data on effectiveness
Ongoing Challenge Rate of unintended pregnancies
“Despite these national recommendations and the plethora of newly published content there are many challenges to ensuring that all women of childbearing age in the United States receive preconception care services that will enable them to enter pregnancy in optimal health “
Preconception Care Solutions Integrating PCC into other public health
programs accessed by women at risk for unintended pregnancy STD clinics in unique position to offer PCC information
• Women at high risk for contracting STD also at high risk for unintended pregnancy
• More likely to have modifiable medical and behavioral risks• STD clinics have skilled counselors• Service admirable to expansion of preconception
counselingo Similar content- risk assessment, education, client-
centered intervention
Previous Studies vs Present Study Previous Studies-
Ignore counselors focus on doctors and nurses
Present Study- Assess counselor perception of PCC importance Identify factors that affect willingness of counselors to
integrate PCC into STD clinics
Initial Questionnaire Development Initial Draft- self-administered, structured,
closed- end questionnaire utilizing questions modified from:
• March of Dimes, Folic Acid and the Prevention of Birth defects, and ACOG surveys
Pretested by 10 former STD counselors currently working as project managers at CDC
6 questions assessed:• Completion time• Level of complexity• Readability• InterestInitial- - self-administered, structured, closed-end
questionnaire
Final Questionnaire Final Draft solely professional attributes no
demographics Questionnaire emailed to current and former STD
counselors in urban ,suburban, and rural areas of US• Counselors found through CDC listing• All counselors had at least 2 years experience providing HIV
pretest/posttest counseling and syphilis interviewing
201 counselors emailed, 140 (71.4%) counselors participated and signed IRB consent form
Final- - self-administered, structured, closed-end questionnaire
Counselor Classifications Level of responsibility
Lower level- counselors and first line supervisors Higher level- managers and administration
Level of Syphilis Morbidity High morbidity- primary and secondary case rate
>2.0/100,000 population Moderate morbidity- primary and secondary case rate
1.0-2.0/100,000 population Low morbidity- primary and secondary case rate
<1.0/100,000 population
Counselor Classifications Knowledge of PCC counseling Years of experience providing STD
counseling Are patients asked about PCC issues? (i.e.,
obesity, drug use, smoking, diabetes, physical activity, asthma, cardiovascular disease)
Does clinic provide referrals for high risk issues?
How prepared are you to provide PCC counseling?
Major Characteristics of Study Participants and Clinics
Lowe
r
High
er
Exce
llent
Good
Poor
2 --
5
6--1
0
> 10 Ye
s No Yes No
Very
pre
pare
d
Som
ewha
t pre
pare
d
Not p
repa
red
High
Mode
rate
Low
Level of re-sponsibility
Knowledge of PCC Years of Experience Clinic refer-rals for PCC
Do you ask about PCC
How prepared are you to deliver PCC
Level of Syphillis morbidity
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
81%
97%100%91%
69%63%
91%88%86%83%85%81%81%
93%
72%
92%86%
45%
PCC is Important ?
Lowe
r
High
er
Exce
llent
Good
Poor
2 --
5
6--1
0
> 10 Ye
s No Yes No
Very
pre
pare
d
Som
ewha
t pre
pare
d
Not p
repa
red
High
Mode
rate
Low
Level of re-sponsibility
Knowledge of PCC Years of Experience Clinic refer-rals for PCC
Do you ask about PCC
How prepared are you to deliver PCC
Level of Syphillis morbidity
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
51%
78%75%81%
14%23%
57%
81%
63%
51%59%
48%
81%72%
24%
75%
31%
15%
Preconception Care Should be Delivered?
Lowe
r
High
er
Exce
llent
Good
Poor
2 --
5
6--1
0
> 10 Ye
s No Yes No
Very
pre
pare
d
Som
ewha
t pre
pare
d
Not p
repa
red
High
Mode
rate
Low
Level of re-sponsibility
Knowledge of PCC Years of Experience Clinic refer-rals for PCC
Do you ask about PCC
How prepared are you to deliver PCC
Level of Syphillis morbidity
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
58%
78%75%80%
33%
47%
60%
84%
64%61%63%62%69%
74%
41%
75%
52%
25%
Interconception Care Should be Delivered?
Univariate Results: Most likely to report PCC as important and believe in
PCC and ICC delivery High level of responsibility Good or excellent knowledge of PCC >5 years of experience Moderate or high level of syphilis morbidity
Series10
1020304050607080
PCC Findings Findings Reveal
Mostly all STD counselors report PCC was important but counselors vary on whether PCC should be delivered
Cannot make conclusion about some factors Reason for varied findings
Counselors recognize interrelationship between PCC and STD
Counselors predisposed to HIV and hepatitis B integration attempts
Counselors already asking patients about high-risk behaviors
PCC Study Limitations Focus on integration of PCC into STD clinics
No account for variability among clinics and counselors Difficult to evaluate effect of counseling session Findings not generalizable to other professionals ( i.e.,
nurses and social workers) Self reported error assessing level of knowledge and
attributes
What’s Next? STD clinics may be plausible alternative for
targeting females who might not otherwise receive PCC benefits CDC guidelines for STD clinic sessions tailored to provide
PCC counseling Additional PCC training for STD counselors
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Failure to provide adequate medical consultation and care before
conception for both planned and unplanned pregnancies will
continually result in long term consequences for parents and
children
National Center on Birth Defects and Developmental DisabilitiesPlace Descriptor Here