Dion, Melissa M, MD

Magdaleno, Angela

Perilli, Gretchen, MD

Vengrove, Marc, DO, FACP

Venkataraman, Sandhya, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Preconception Counseling: Frequently Forgotten by Primary Care Providers Due to Multiple Barriers Angela Magdaleno Lehigh Valley Health Network, angela.magdaleno@lvhn.org Sandhya Venkataraman DO Lehigh Valley Health Network, Sandhya.Venkataraman@lvhn.org Melissa M. Dion MD Lehigh Valley Health Network, Melissa.Dion@lvhn.org Gretchen Perilli MD Lehigh Valley Health Network, gretchen_a.perilli@lvhn.org Marc Vengrove DO, FACP Lehigh Valley Health Network, Marc.Vengrove@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Medicine and Health Sciences Commons Published In/Presented At Magdaleno, A. Venkataraman, S. Dion, M. Perilli, G. Vengrove, M. (2018, March). Preconception Counseling: Frequently Forgotten by Primary Care Providers Due to Multiple Barriers. Poster Presented at:The National Endocrinology Society Meeting. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2018 Lehigh Valley Health NetworkINTRODUCTION•  Primary objective was to estimate the percentage of women 18-35 years old with type 1 or type 2 DM who received PC from primary care providers: family medicine (FM), internal medicine (IM), and obstetrics and gynecology (OB) physicians in Lehigh Valley Health Network (LVHN)•  Secondary objective was to create a survey to determine barriers preventing health care providers from providing PC. •  Patient population included women ages 18-35 with type 1 or type 2 DM with or without complications that had a non-acute office visit with FM, IM, or OB between June 1, 2014 and June 30, 2016. A total of 2750 charts were identified and 577 of these met inclusion criteria.•  Office notes were reviewed to determine if the patient received PC at the office visit. •  Additionally, an electronic survey was created to evaluate barriers to providing PC. The survey was sent to 524 FM, IM, and OB providers within the Lehigh Valley Health Network.•  In conclusion, the rate of PC provided at LVHN does not meet the ADA guidelines. •  OB provided the most PC at LVHN, which may be due to their patient population being females of childbearing age. •  Based on survey responses, providers believe they are supplying PC more regularly than they are. While 39.2% of providers believe they perform PC regularly, only 18.9% are providing counseling in a 3-year period.•  Furthermore, providers would be more likely to provide PC if women initiated the discussion and if they had more time/extra appointment.•  Educating providers on the need to initiate and incorporate PC discussions in an efficient manner during routine visits may improve the rates of PC in women with pre-existing DM.OBJECTIVES AND METHODS:CONCLUSIONS:•  For the primary objective, 109 patients (18.9%) received PC during an office visit in the past 3 years. •  There was a statistically significant association between specialty and providing PC: OB visits had a higher proportion of women who received PC (36.1%) compared to IM (9.82%) and FM (7.11%). •  Of the 524 surveys emailed to providers, 97 surveys were completed (18.5%). •  The overall survey responses revealed that providers would like more time during an appointment to discuss PC and another appointment to discuss PC. In addition, they felt that unplanned pregnancies are a barrier and that women should ask for PC. •  Furthermore, surveys showed that providers think they are providing PC more often than it is documented in patient charts that it is actually provided.RESULTS:•  Preconception counseling (PC) is defined as organized care specifically targeted for women with diabetes mellitus (DM) that are preparing for pregnancy with the main goal of optimizing their glycemic control prior to conception.•  For the purpose of this study, PC was defined as one of the following:  −  General discussion about the benefits of glycemic control prior to conception and during pregnancy for those women not currently considering conception.  −  Discussion of future plans for pregnancy and rationale for strict glycemic control and or transitioning to appropriate diabetic regimen in those women considering pregnancy in the near future.  −  Discussion of contraception in women with DM specifically noting importance of tight glycemic control prior to conception.•  The American Diabetes Association (ADA) recommends that all women of childbearing age with DM receive PC beginning at puberty. Figure 1: Provider Survey. (A) Initial view when open survey. (B) Additional questions if provider chooses the answer that they do not regularly provide preconception counseling to patients.(A) Initial view when survey is opened.(B) Additional questions if provider chooses the answer that they do not provide preconception counseling to patients.40%30%20%10%0%6.78%Not Enough Time5.08%33.90%30.51%23.73%10.17%Another Appointment10.17%16.95%18.64%44.07%30.51%Not Reimbursed22.03%32.20%3.39%11.86%16.95%Pregnancies are Unplanned23.73%28.81%20.34%10.17%40%30%20%10%0%3.39%6.78%23.73%37.29%28.81%Woman Should Ask20.34% 20.34%23.73%22.03%13.56%Don’t Have Training42.37%Unsure of Risks30.51%11.86%10.17%5.08%40%30%20%10%0%20.34%18.64%32.20%22.03%6.78%Another Physician Does It35.59%38.98%18.64%6.78%Unsure of ContraindicationsStrongly Disagree Disagree Neutral Agree Strongly AgreePercentage1Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA, 2Department of Obstetrics/Gynecology, Lehigh Valley Health Network, Allentown, PA, 3Department of Internal Medicine, Division of Endocrinology, Lehigh Valley Health Network, Allentown, PAPreconception Counseling: Frequently Forgotten by Primary Care Providers Due to Multiple BarriersAngela Magdaleno, DO1, Sandhya Venkataraman, DO1, Melissa Dion, MD2, Gretchen Perilli, MD3 and Marc Vengrove, DO, FACP3Table 1. Descriptive Statistics for the Study Sample (N=577) Total(N=577)Received PC    Within Past 3 Years(N=109)Did Not Receive PC Within Past 3 Years(N=468)DemographicsRace   Caucasian 355 (61.5) 68 (62.4) 287 (61.3)   African American 56 (9.7) 10 (9.2) 46 (9.8)   Hispanic/Latino 140 (24.3) 29 (26.6) 111 (23.7)   Other 26 (4.5) 2 (1.8) 24 (5.1)Marital Status   Single 347 (60.1) 49 (45.0) 298 (63.7)   Married 186 (32.2) 52 (47.7) 134 (28.6)   Widowed 3 (0.5) 1 (0.9) 2 (0.4)   Divorced 26 (4.5) 5 (4.6) 21 (4.5)   Other 15 (2.6) 2 (1.8) 13 (2.8)Age median (IQR) 30 (25-33) 32 (28-34) 29 (25-33)Clinical CharacteristicsTypes of Diabetes       Type 1 227 (39.3) 37 (33.9) 190 (40.6)   Type 2 350 (60.7) 72 (66.1) 278 (59.4)HbA1c median (IQR) 7.5 (6.3-9.7) 6.9 (6.15-9.15) 7.6 (6.4-9.8)ANumber of Visits Past 3 Years median (IQR) 5 (2-8) 7 (3-11) 4 (2-8)Figure 2. Percentage of Responses within Each Category of PC QuestionsTable 2. Specialty Which Provided Preconception Counseling or  Patient Saw Most Frequently within the Past 3 Years  Family Medicine(N=225)Internal Medicine(N=112)OB/GYN(N=205) p PC Provided <.0001   Yes 16 (7.1) 11 (9.8) 74 (36.1)   No 209 (92.9) 101 (90.2) 131 (63.9)

Preconception Counseling: Frequently Forgotten by Primary Care Providers Due to Multiple Barriers

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2497&context=medicine

Preconception Counseling: Frequently Forgotten by Primary Care Providers Due to Multiple Barriers

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