Prenatal group care within a small family medicine residency clinic STFM Annual Conference, April 26, 2015 Nirali Bora, MD Assistant Professor, MSU–CHM, GR Family Medicine, Spectrum Health Navya Arepalli, MD PGY3, GRMEP

Objectives Describe benefits of group prenatal care for both patients and care providers. Identify challenges to implementing group prenatal care at a small family medicine clinic site. Brainstorm strategies to enhance the sustainability of group prenatal care at a small site.

Background Our experience Conclusions Next Steps Overview *All patients provided consent for their pictures to be used in this presentation

Alternative model of care Group Medical Visits Alternative model of care Used in multiple clinical sites including residencies

Evidence based model of group healthcare Centering Pregnancy® Evidence based model of group healthcare Health assessment Education Support Health assessment occurs within the group space. Participants are involved in self-care activities. A facilitative leadership style is used. The group is conducted in a circle. Each session has an overall plan. Attention is given to the core content, although emphasis may vary. There is stability of group leadership. Group conduct honors the contribution of each member. The composition of the group is stable, not rigid. Group size is optimal to promote the process. Involvement of support people is optional. Opportunity for socializing with the group is provided. There is ongoing evaluation of outcomes.

Studies have shown: Benefits of group prenatal care Decreased odds of preterm birth Improved breastfeeding rates Increased knowledge Increased use of postpartum contraception Lower postpartum depression Improved provider satisfaction

Clinic structure Demographics Breastfeeding rates Spectrum Health FM Residency Center Clinic structure Demographics Breastfeeding rates - Baseline: 51.6% of patients who delivered between 7/1/2012 and 7/1/2013 were exclusively breastfeeding at 6 weeks postpartum. 92.3% of patients who are refugees were exclusively breastfeeding at 6 weeks postpartum while 22% of patients who are not refugees were exclusively breastfeeding at 6 weeks postpartum.

Grand Beginnings Recruitment Participants Structure April 2014, patients with EDC October or November 2014 English speaking pregnant women at least 16 years of age 5 patients met criteria, 3 chose to participate Participants Structure

# group visits attended Results Birth outcomes, contraception, breastfeeding Age # group visits attended GP Education Birth weight GA Delivery Birth control Breast-feeding 6 wk PP 1 19 7/8 (delivered after 7 sessions) G2P0 Some college 3800g 38 2/7 NSVD condom Y 2 21 6/8 G1P0 High school 3605g 40 5/7 Nexplanon N 3 28 8/8 G3P2 3980g 39 3/7 Repeat C-section Mirena IUD

Results Patient Satisfaction Patient Knowledge (pre and post) Edinburgh UCLA Loneliness Scale (pre and post) Patient Edinburgh UCLA Loneliness Scale Pre Post 1 25 20 2 39 26 3 22 28

Patient Comments What I liked best: “It really taught me a lot, as a new mom I had a lot of questions. Before my baby came I was prepared.” “Sharing and learning” “Making friends”

Second group

Successful pilot Limitations Conclusions Recruitment Staff turnover Lack of control group Adequate group space Did not have Centering® certification or training Resident schedule conflicts

Next steps Your thoughts? Collaboration with OB/Gyn residency MSU network Your thoughts?

Thank you Our patients Dr. William Stratbucker Jamie Post, RN Nichole Lambert, MSW Contact us: Nirali Bora (nirali.bora@spectrumhealth.org) Navya Arepalli (navya.arepalli@grmep.org)