Wednesday, June 17, 2015

Near Miss: Interconception Care Success Story

L.Z. was a 10 month old who was scheduled for an ER follow up after an acute illness. It was noted on checking in that the child had missed the 9 month WCC so instead of just doing a quick visit (as the child was better), the MA and provider decided to take care of the 9 month WCC. Because MAHEC FHC performs interconception care screening questions on all mom’s at WCCs, L.Z.’s mom was asked the usual screening questions to assess risks. Turns out L.Z’s mom was not taking her multivitamin any more, had restarted smoking (had previously quit during pregnancy), was actively stressed and mildly depressed due to relationship issues with a PHQ9 of 14 and was on no contraception (she stopped her pill several months ago). She had screened positive for all 4 of our interconception risks!

Looking back, at the initial few newborn visits all was well – at 2 months she was on a multivitamin, not smoking, not depressed and taking the birth control pill. She had missed the 4 month WCC visit. No ICC was documented at the 6 month WCC.

L.Z.’s mom received attention at that 9 month WCC. She was assessed by behavioral health and made a follow up appointment for counselling support. She received counselling about unintended pregnancy and importance of birth spacing of at least 18 months before conceiving again – she decided to get a nexplanon. She received a year supply of multivitamins to take and was encouraged to quit smoking – to be addressed more at future visits.

I recently saw L.Z. back at the 15 month WCC visit. Life is still a bit stressful, but mom’s PHQ9 is now 9 and she feels more supported. She quit smoking again, is taking a multivitamin daily and got her nexplanon 2 weeks after that 10 month visit without any problems.

This is a great reminder of how important it is for us to ask these questions each time. If we had not done the WCC at that visit, if we had not done the ICC screenings, it is highly probable none of those risks would have been identified and the next visit may have been for an unintended pregnancy with a higher risk for poor birth outcome.

There is no doubt in my mind: our interconception care model is working to reduce maternal health risks and is improving people’s lives. Healthy mother, healthy family.

Thursday, December 11, 2014


Members of the IMPLICIT network presented a poster about Interconception Care (ICC) last month at the annual North American Primary Care Research Group (NAPCRG) meeting in New York.  The energy and excitement of this inter-professional, international conference provided a great opportunity to showcase preliminary ICC data.  Our poster shared exciting results from nearly 2,700 unique babies being followed with our innovative model of using WCVs to screen mothers.

We generated a lot of traffic and interest in the project from a range of health professionals with different backgrounds.  From medical students to residency faculty to community health workers to practicing physicians, providers were eager to learn more about the rationale and feasibility of implementing ICC in their settings.  Many researchers gave positive feedback, validating the work that the network is doing in this arena.  Some words used to describe the work were “intuitive” and “brilliant”.   As we continue to disseminate ICC across primary care disciplines, we know others will agree wholeheartedly!

Monday, August 25, 2014

FMEC IMPLICIT Network Overview

The Family Medicine Education Consortium (FMEC) IMPLICIT Network is celebrating its 10th year of sustained collaboration.  There are now nine residencies in the network who have implemented Interconception Care (ICC) of mothers as part of our care provided during well baby and well child care visits up to 2 years of age.  We need a forum where we can share the successes and challenges of implementing this care model.  My question for today is how will we know from a population health basis that this model of ICC is improving quality of life and health care outcomes for women and their families?  Before we implemented this model, we did a baseline survey of mothers during their well child care visits of their one and two year olds.  At this time, we could replicate this study to see if mothers in participating practices have experienced a change in the frequency of ICC they have received from their family doctors during the previous year.  We can then compare this data with the baseline study.  What other outcomes could we study?