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Article ; Online: Preconception Care Is Primary Care: A Call to Action.

Frayne, Daniel J

2018 Volume 96, Issue 8, Page(s) 492–494

MeSH term(s)	Cardiovascular Diseases ; Chronic Disease ; Diabetes Mellitus/therapy ; Evidence-Based Medicine ; Female ; Folic Acid/therapeutic use ; Humans ; Hypertension/diagnosis ; Hypertension/therapy ; Infant ; Infant Mortality ; Male ; Maternal Mortality ; Overweight/diagnosis ; Overweight/therapy ; Preconception Care ; Primary Health Care ; Sexually Transmitted Diseases/diagnosis ; Sexually Transmitted Diseases/drug therapy ; United States ; Vitamin B Complex/therapeutic use
Chemical Substances	Vitamin B Complex (12001-76-2) ; Folic Acid (935E97BOY8)
Language	English
Publishing date	2018-01-09
Publishing country	United States
Document type	Editorial
ZDB-ID	412694-4
ISSN	1532-0650 ; 0002-838X ; 0572-3612
ISSN (online)	1532-0650
ISSN	0002-838X ; 0572-3612
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Article ; Online: Measuring Female Veterans' Prepregnancy Wellness Using Department of Veterans Affairs' Health Record Data.

Quinn, Deirdre A / Mor, Maria K / Sileanu, Florentina E / Zhao, Xinhua / Callegari, Lisa S / Zephyrin, Laurie C / Frayne, Daniel J / Borrero, Sonya

Obstetrics and gynecology

2021 Volume 137, Issue 3, Page(s) 471–480

Abstract: Objective: To estimate the feasibility of using measures developed by the Clinical Workgroup of the National Preconception Health and Health Care Initiative to assess women's prepregnancy wellness in a large health care system.: Methods: We examined ... ...

Abstract	Objective: To estimate the feasibility of using measures developed by the Clinical Workgroup of the National Preconception Health and Health Care Initiative to assess women's prepregnancy wellness in a large health care system. Methods: We examined Department of Veterans Affairs' (VA) national administrative data, including inpatient, outpatient, fee-basis, laboratory, pharmacy, and screening data for female veterans aged 18-45 who had at least one pregnancy outcome (ectopic pregnancy, spontaneous abortion, stillbirth, and live birth) during fiscal years 2010-2015 and a VA primary care visit within 1 year before last menstrual period (LMP). LMP was estimated from gestational age at the time of pregnancy outcome, then used as a reference point to assess eight prepregnancy indicators from the Workgroup consensus measures (eg, 3 or 12 months before LMP). Results: We identified 19,839 pregnancy outcomes from 16,034 female veterans. Most (74.9%) pregnancies ended in live birth; 22.6% resulted in spontaneous abortion or ectopic pregnancy, and 0.5% in stillbirth. More than one third (39.2%) of pregnancies had no documentation of prenatal care within 14 weeks of LMP. Nearly one third (31.2%) of pregnancies occurred in women with obesity. Among pregnancies with a recent relevant screening, 29.2% were positive for smoking and 28.4% for depression. More than half (57.4%) of pregnancies in women with preexisting diabetes did not have documentation of optimal glycemic control. Absence of sexually transmitted infection screening in the year before or within 3 months of LMP was high. Documentation of prenatal folic acid use was also high. Exposure in the same timeframe to six classes of teratogenic medications was low. Conclusion: Despite limitations of administrative data, monitoring measures of prepregnancy wellness can provide benchmarks for improving women's health across health care systems and communities. Areas for intervention to improve female veterans' prepregnancy wellness include healthy weight, optimizing control of diabetes before pregnancy, and improved use and documentation of key prepregnancy health screenings.
MeSH term(s)	Adolescent ; Adult ; Female ; Health Status ; Humans ; Middle Aged ; Pregnancy ; Pregnancy Outcome/epidemiology ; Retrospective Studies ; United States/epidemiology ; United States Department of Veterans Affairs/statistics & numerical data ; Veterans/statistics & numerical data ; Young Adult
Language	English
Publishing date	2021-02-04
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000004293
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Article ; Online: Free pregnancy testing increases maternity care volume in family medicine residencies.

Oat-Judge, Julia / Galvin, Shelley L / Frayne, Daniel J

Family medicine

2015 Volume 47, Issue 6, Page(s) 470–473

Abstract: Background and objectives: Increased prenatal volume in family medicine residencies is associated with a higher proportion of graduates including maternity care in their post-residency practices. However, family medicine residencies struggle just to ... ...

Abstract	Background and objectives: Increased prenatal volume in family medicine residencies is associated with a higher proportion of graduates including maternity care in their post-residency practices. However, family medicine residencies struggle just to meet the Residency Review Committee's minimum requirements for maternity care volume. Our objective was to evaluate the effectiveness of free pregnancy testing on increasing maternity care volume in our residency. Methods: In this before-after intervention study, free pregnancy testing was offered at the residency's Family Health Center (FHC) from May 2011 through November 2012 to established patients and non-patients. Participants with positive tests were provided information on maternity care and an opportunity to schedule an initial prenatal visit. The primary outcome was the percentage of self-referred patients who established prenatal care at FHC. Results: Over 19 months, 241 tests were performed on 224 women with a mean age of 26.2±6.3. Over half were minorities (130 [58%]). Most were under-insured or uninsured (193 [86.1%]). Ninety-nine women (41.1%) had positive tests; 74 of these 99 women (74.7%) established prenatal care at FHC, and 57 of these 74 women (77%) were new patients. The number of obstetric patients increased 13% from 405 to 456 patients. The percentage of self-referred patients increased from 31.9% to 40.8% (P<.001). The total cost of 241 pregnancy tests was $256.24, and maternity care revenue for just one patient was $1,553. Conclusions: The program's return on investment is favorable. Offering free pregnancy testing is a simple and inexpensive way to increase maternity care volume in a family medicine residency.
MeSH term(s)	Adolescent ; Adult ; Family Practice/education ; Humans ; Internship and Residency/organization & administration ; Maternal Health Services/economics ; Maternal Health Services/organization & administration ; Medically Uninsured/statistics & numerical data ; Middle Aged ; Minority Groups/statistics & numerical data ; Pregnancy Tests/economics ; Prenatal Care/statistics & numerical data ; Young Adult
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639374-3
ISSN	1938-3800 ; 0742-3225
ISSN (online)	1938-3800
ISSN	0742-3225
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Article ; Online: Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study.

DeMarco, Mario P / Shafqat, Maha / Horst, Michael A / Srinivasan, Sukanya / Frayne, Daniel J / Schlar, Lisa / Barr, Wendy Brooks

Maternal and child health journal

2020 Volume 25, Issue 2, Page(s) 207–213

Abstract: Introduction: Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including folic acid reduce the incidence of these birth defects. Most women do not take ... ...

Abstract	Introduction: Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including folic acid reduce the incidence of these birth defects. Most women do not take recommended levels of folic acid prior to conception or during the interconception period. Methods: The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) ICC model was implemented to screen mothers who attend well child visits (WCVs) for their children aged 0-24 months. Mothers were queried for maternal behavioral risks known to affect pregnancy including multivitamin use and use of family planning methods to enhance birth spacing. When appropriate, interventions targeted at those at risk behaviors are offered. A mixed effects logistic regression model was used to calculate the odds ratio (OR) of behavior change in MVI use among mothers who reported not using MVIs. Results: 37.7% of mothers reported not using MVIs at WCVs. 64.0% of mothers received an intervention to improve MVI use in this model. Mothers who received an intervention were more likely to report taking an MVI at the subsequent WCV if they received advice to take MVIs (OR 1.64) or directly received MVI samples (OR 3.09). Conclusions: Dedicated maternal counseling during pediatric WCVs is an opportunity to influence behavioral change in women at risk of becoming pregnant. Direct provision of MVIs increases the odds that women will report taking them at a higher rate than provider advice or no counseling at all.
MeSH term(s)	Adult ; Female ; Folic Acid/administration & dosage ; Humans ; Incidence ; Infant, Low Birth Weight/physiology ; Mothers/psychology ; Mothers/statistics & numerical data ; Neural Tube Defects/prevention & control ; Preconception Care/methods ; Preconception Care/organization & administration ; Premature Birth/prevention & control ; Vitamins/administration & dosage
Chemical Substances	Vitamins ; Folic Acid (935E97BOY8)
Language	English
Publishing date	2020-11-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339905-6
ISSN	1573-6628 ; 1092-7875
ISSN (online)	1573-6628
ISSN	1092-7875
DOI	10.1007/s10995-020-03055-6
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Article ; Online: Delivering Interconception Care During Well-Child Visits: An IMPLICIT Network Study.

Srinivasan, Sukanya / Schlar, Lisa / Rosener, Stephanie E / Frayne, Daniel J / Hartman, Scott G / Horst, Michael A / Brubach, Jessica L / Ratcliffe, Stephen

Journal of the American Board of Family Medicine : JABFM

2018 Volume 31, Issue 2, Page(s) 201–210

Abstract: Background: Preterm birth, birth defects, and unintended pregnancy are major sources of infant and maternal morbidity, mortality, and associated resource use in American health care. Interconception Care (ICC) is recommended as a strategy to improve ... ...

Abstract	Background: Preterm birth, birth defects, and unintended pregnancy are major sources of infant and maternal morbidity, mortality, and associated resource use in American health care. Interconception Care (ICC) is recommended as a strategy to improve birth outcomes by modifying maternal risks between pregnancies, but no established model currently exists. The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network developed and implemented a unique approach to ICC by assessing mothers during their baby's well-child visits (WCVs) up to 24 months. Methods: Mothers who accompanied their children to WCVs at eleven eastern US family medicine residency programs underwent screening for four risk factors (tobacco use, depression risk, contraception use to avoid unintended pregnancy and prolong interpregnancy interval, and use of a multivitamin with folic acid). Positive screens in women were addressed through brief interventions or referrals to treatment. Results: Mothers accompanied their babies to 92.7% of WCVs. At more than half of WCVs (69.1%), mothers were screened for presence of ICC behavioral risks, although significant practice variation existed. Risk factors were identified at significant rates (tobacco use, 16.2%; depression risk, 8.1%; lack of contraception use, 28.2%; lack of multivitamin use, 45.4%). Women screened positive for 1 or more ICC risk factor at 64.6% of WCVs. Rates of documented interventions for women who screened positive were also substantial (tobacco use, 80.0%; depression risk, 92.8%; lack of contraception use, 76.0%; lack of multivitamin use, 58.2%). Conclusion: WCVs provide a reliable point of contact with mothers and a unique opportunity to assess and address behavioral risks for future poor birth outcomes.
MeSH term(s)	Adolescent ; Adult ; Child ; Congenital Abnormalities/etiology ; Congenital Abnormalities/prevention & control ; Contraception/methods ; Family Practice/methods ; Feasibility Studies ; Female ; Health Risk Behaviors ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Mothers/education ; Patient Education as Topic ; Postnatal Care/methods ; Preconception Care/methods ; Pregnancy ; Pregnancy, Unplanned ; Premature Birth/etiology ; Premature Birth/prevention & control ; Prenatal Care/methods ; Risk Factors ; Young Adult
Language	English
Publishing date	2018-02-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2018.02.170227
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Article ; Online: Pruritic erythematous maculopapular rash.

Monckton, Robyn / Fagan, Blake / Frayne, Daniel J / Colvin, Gaye F

The Journal of family practice

2011 Volume 60, Issue 10, Page(s) 613–615

Abstract: A trip to the beach left this patient with an unusual rash where his bathing suit had been. ...

Abstract	A trip to the beach left this patient with an unusual rash where his bathing suit had been.
MeSH term(s)	Acantholysis/diagnosis ; Adult ; Animals ; Bites and Stings/complications ; Bites and Stings/diagnosis ; Diagnosis, Differential ; Erythema/etiology ; Exanthema/etiology ; Folliculitis/diagnosis ; Humans ; Ichthyosis/diagnosis ; Male ; North Carolina ; Photosensitivity Disorders/diagnosis ; Pruritus/etiology ; Scyphozoa ; Seawater ; Swimming ; Trematoda
Language	English
Publishing date	2011-10
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	197883-4
ISSN	1533-7294 ; 0094-3509
ISSN (online)	1533-7294
ISSN	0094-3509
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Article ; Online: Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study.

Rosener, Stephanie E / Barr, Wendy B / Frayne, Daniel J / Barash, Joshua H / Gross, Megan E / Bennett, Ian M

Annals of family medicine

2016 Volume 14, Issue 4, Page(s) 350–355

Abstract: Purpose: Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and ... ...

Abstract	Purpose: Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. Methods: We surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child's physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice. Results: Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P <.05). Most mothers, nearly 95%, were willing to accept health advice from their child's physician regardless of whether a medical home was shared (P >.05). Conclusions: Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child's physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes.
MeSH term(s)	Child ; Cross-Sectional Studies ; Family Planning Services/organization & administration ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Infant, Newborn ; Mothers/psychology ; Mothers/statistics & numerical data ; Preconception Care/organization & administration ; Preconception Care/standards ; Primary Health Care/organization & administration ; Surveys and Questionnaires
Language	English
Publishing date	2016-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171425-3
ISSN	1544-1717 ; 1544-1709
ISSN (online)	1544-1717
ISSN	1544-1709
DOI	10.1370/afm.1933
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Article ; Online: Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

Frayne, Daniel J / Verbiest, Sarah / Chelmow, David / Clarke, Heather / Dunlop, Anne / Hosmer, Jennifer / Menard, M Kathryn / Moos, Merry-K / Ramos, Diana / Stuebe, Alison / Zephyrin, Laurie

Obstetrics and gynecology

2015 Volume 127, Issue 5, Page(s) 863–872

Abstract: Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status ... ...

Abstract	Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements.
MeSH term(s)	Benchmarking ; Delivery of Health Care ; Female ; Global Health ; Humans ; Preconception Care ; Pregnancy ; United States ; Women's Health Services
Language	English
Publishing date	2015-12-09
Publishing country	United States
Document type	Consensus Development Conference ; Journal Article
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000001379
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