Healthy Mom, Healthy Family Wave 1 Action Period Call 5 July 21, 2021
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Healthy Mom, Healthy Family
Wave 1
Action Period Call 5
July 21, 2021
Welcome
Thank You! • Ohio Department of Health – State Sponsor and Funder, Content Experts • Government Resource Center –Administrator, Data Support and QI Experts • March of Dimes –Implicit Network Support and Content Experts • Ohio Chapter, AAP –Implementation, Practice Support, and QI/Content Experts
Agenda • Data: Review, Discussion and Submission Updates –Hayley Southworth –Using Data in Planning Changes • Covid Vaccine in Pregnancy & Breastfeeding – Lisbeth Lazaron, MD • Motivational Interviewing: Practice Sharing and Discussion/Roll Call • QI Corner • Due Dates and Reminders
Data: Review, Discussion and Submission Updates
Data Review
• Data submissions update
Month # Sites # Submissions
March 5 84
April 8 76
May 7 118
June 9 173
Total 9 451
6Data Review
7Data Review
8Data Review
% Positive % Referrals
Screens Provided
Maternal Mental
Health 20.1 43.8
Tobacco Use 26.3 80
Multivitamin 46.9 41.3
Family Planning 93.6 31.8
9Data Review
% Positive % Referrals
Screens Provided
Maternal Mental
Health 20.1 43.8
Tobacco Use 26.3 80
Multivitamin 46.9 41.3
Family Planning 93.6 31.8
10Using Data to Plan Changes • Look for gaps in identified needs and interventions • Select a topic with areas for improvement –Start with a narrow focus –Assess positive/negative results –Spread to other topics, providers • Document changes tested –Make a meaningful part of PDSA cycles
Questions?
Covid Vaccine in Pregnancy & Breastfeeding Lisbeth Lazaron, MD, FAAFP July 2021
References & Resources
Immunization Action Coalition update 6/17/21 www.immunize.org/covid-19/
one stop resource for most up to date ACIP, CDC vaccine information
CDC update 6/29/21 www.cdc.gov/vaccines/covid-19/clinical-
considerations/covid-19-vaccines-us.html#pregnant
SMFM & AWHONN update 5/26/21 www.awhonn.org/novel-coronavirus-
covid-19/ Great patient education resources for pregnant & lactating women
ACOG update 7/2/21 www.acog.org/clinical/clinical-guidance/practice-
advisory/articles/2020/12/covid-19-vaccination-considerations-for-
obstetric-gynecologic-care Most current safety data
V-Safe www.vsafe.cdc.org for smartphone usersWhy get a Covid vaccine in pregnancy?
The negative effects of Covid infection while pregnant
-- Pregnant women are 3 x more likely to need ICU care
-- 2-3 X more likely to need advanced life support or a breathing tube
-- have a small increased risk of dying of Covid
-- have an increased risk of still birth and preterm birth
These risks are even higher if the mom has diabetes, heart disease,
a BMI>35, or are Black or LatinaWhy get a Covid vaccine in pregnancy?
The positive benefits from the vaccine (data from V-safe
and Pfizer & Moderna trials)
Condition No vaccine Had vaccine
Miscarriage 20 weeks 0.6% 0.1%
Preterm birth 8-15% 9.4%
Small for GA 3.5% 3.2%
Congenital anomalies 3% 2.2%
Neonatal death 0.38% 0%Why get a Covid vaccine in pregnancy? The cautions: -- side effects are common for the first 3 days which include fever, headache and muscle aches, as well as axillary adenopathy, that some lactating women may confuse with mastitis. Tylenol is OK to use at any time in pregnancy. -- the J & J vaccine has an rare risk of TTS (thrombosis & thrombocytopenia syndrome) in people
Covid vaccine fallacies
Claims linking infertility to Covid vaccine are
unfounded and had no scientific basis
Co-administration: Covid vaccine can be given at
same time as Influenza or Tdap or RhoGAM
Pregnant women do NOT need physician prior
approval to receive this vaccineWhy get a Covid vaccine while breastfeeding? The positives benefits from the vaccine -- In a recent study* of vaccinated moms, antibodies were found in both the umbilical cord blood of babies AND in mother’s breastmilk. -- By getting the vaccine, the mother is both protecting herself AND her baby. *Gray KJ “Covid-19 vaccine response in pregnant and lactation women: a cohort study” Am J Obstet Gynecol 2021 Mar 24
Why get a Covid vaccine while breastfeeding? The cautions: -- side effects are common for the first 3 days which include fever, headache and muscle aches, as well as axillary adenopathy, that some lactating women may confuse with mastitis. -- Tylenol or ibuprofen is OK to use at any time in breastfeeding women.
V-safe
Covid-19 Vaccine pregnancy monitoring registry
A voluntary smartphone based tool using text messaging and web surveys to provide
personal health check-ins after the Covid vaccine
-- patients can enroll through www.vsafe.cdc.org
-- receive daily texts for symptom reporting for 7 days
-- receive weekly texts for symptom reporting for 6 weeks
-- get reminders on timing of their second vaccine
-- Someone will call from the CDC (which may be an Atlanta, GA phone
number) to ask initial questions and get more information.
-- They may be asked to enroll in the vaccine pregnancy registry, which
is collecting information about any effects of the vaccine during
pregnancy.
As of July 12 133,466 pregnant women have been monitored through V-SafeGetting Covid vaccine to our families
Provide vaccine advice that is knowledgeable and supportive
of patient concerns
Eliminate institutional or environmental barriers to
vaccination
If you vaccinate children, consider vaccinating families!
Personal anecdotes help! Share with your families that you
are vaccinated and that your family members are too!Practice Discussion/Sharing
THE TRUE DIFFERENCE TO MI
Listening for
change talk
versus
arguing for
change
(via informing) 24THE TRUE DIFFERENCE TO MI
Out of whose mouth does
the change talk come from?
Don’t take all the good lines!
It’s the patient who should voice
the arguments for change.
25IMPORTANCE
“On a scale from 0 to 10, with 0 being not at all important and 10 being
very important, how important is it for you to (insert healthy behavior)?”
0 1 2 3 4 5 6 7 8 9
10
The next question is:
Why are you a (4) and not a (3)?
What would it take to get you to a (5) ?
26CONFIDENCE
“On a scale from 0 to 10, with 0 being not at all sure and 10 being very
sure, how confident are you that you could (insert healthy behavior)?”
0 1 2 3 4 5 6 7 8 9
10
The next question is:
Why are you a (4) and not a (3)?
What would it take to get you to a (5) ?
27Roll Call and Practice Sharing
• Do you see a place for these tools in practice?
• What barriers might there be to use MI tools?
• How often do you actually use MI?
• Adebowale A Adedipe MD INC • MetroHealth
• Bethesda Family Practice – Broadway Primary Care
• Beavercreek Family Medicine – Ohio City Primary Care
– Ohio City Pediatrics
• Grant Family Medicine
• Riverside Family Practice
• Lima Memorial Medical Center -
Wapakoneta
• Margaret B. Shipley Child Health Clinic
• Mercy Health Jefferson Family PracticeQI Corner: Becoming a PDSA “Doer”
• Key elements of the Do stage:
– Start to implement your action plan
• Now that you have a plan, start with a small test – 1 afternoon, 1 day, 1 week
– Be sure to collect data as you go, to help you evaluate your plan in the
next phase, Study
• Use the data collection form to capture what is occurring
• Your team should also document problems, unexpected effects, and general
observations
– Your team might find it helpful to use a flowchart or office flow
diagram in this stage to capture data/occurrences as they happen
– Engage all team members in this phase – capture feedback from office
staff who are part of the process (MAs, nurses, etc.)QI Corner: Becoming a PDSA “Doer”
QI Corner: Becoming a PDSA “Doer”
Due Dates and Reminders
Mark Your Calendars • First Data Submission: – Data for July should be submitted by August 3, 2021 • Next Action Period Call: – August 18, 12:00 pm
Questions?
Wrap-Up
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