Interconception Care to Enhance Multivitamin Use
Shaza Khan, DO; Lisa Schlar, MD; Stephanie Ballard, PharmD, BCPS; Jessica Brubach, MPA
Introduction:
The IMPLICIT interconception care (ICC) model uses maternal attendance at Well Child Visits from 0-24 months to screen women for interventions targeting healthy subsequent pregnancies. ICC assesses tobacco use, depression, contraception and multi-vitamin use (MVI) (for reduction of neural tube defects, preterm birth, and congenital malformations).
Methods:
A two-cycle Plan-Do-Study-Act approach was used to enhance MVI use at SFHC. Prior interventions (standing MVI order, ICC sticker for flowsheet and ICC dot phrase) were tracked for baseline data (Jul 2017 – Oct 2018). PDSA cycle 1 (Nov 2018 - Dec 2018) included revised patient education materials, reminders to physicians and clinical staff during team huddles, and a revised MVI magnet for team signaling during visits. Cycle 2 (Jan 2019) included further patient education material revision, demonstration/troubleshooting of ICC documentation, and provider report cards and education at precepting stations.
Results:
Preintervention MVI screening rates were 73.7% (n=494); of those screened, 35% were non-users, and among non-users 83.5% received an intervention. Dot phrase usage was 84%. After PDSA Cycle 1, screening rates were 63.8% (n=64); 30.7% of those screened were non-users and among non-users 94% received an intervention. Dot phrase usage declined from preintervention period to 72%. After PDSA Cycle 2, screening rates were 82% (n=84) and 23.4% of those screened were non-users, 86% of non-users received an intervention. Dot phrase usage increased to 88%.
Conclusion:
A multifaceted, 2-cycle intervention to increase screening and intervention for MVI use in childbearing-age women between pregnancies did not significantly impact overall MVI intervention but did affect individual prescriber patterns.