A Visit to the Pediatrician as a Part of Comprehensive Prenatal Care?

INTRODUCTION: The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that expectant parents receive a preventive visit with a pediatrician in the prenatal period (a pediatric prenatal visit, or PPV). Discussing newborn health topics in the prenatal period tends to be more effective than immediately postpartum, and research suggests, for example, that the PPV increases timely childhood immunizations. However, only 22% of expectant parents have these visits, and there are significant disparities by race and income. METHODS: A 2-min online survey with open-ended questions was emailed to 304 eligible obstetrics providers in Rochester, NY. Simple descriptive statistics and chisquare analysis were applied to survey responses. Responses were organized within the framework of knowledge, attitudes, and practices to identify barriers to guideline adherence resulting in chronic under-utilization of the PPV. RESULTS: Ninety obstetric providers completed the survey. 66 reported awareness of the PPV, and 45 reported referring patients for a PPV. However, in open-ended questions, respondents expressed confusion between the PPV and a "meet and greet" visit with a pediatrician. Some respondents believed that the PPV is not covered by insurance, even though these visits are covered by Medicaid and marketplace insurance. Providers who had personally received one as a parent expressed positive attitudes. DISCUSSION: These findings indicate that unfamiliarity with the PPV is one barrier to referral. Educating providers about the guideline recommendations, evidence base, and insurance coverage could overcome this barrier. Doing so could reduce disparities in utilization of the pediatric prenatal visit.

What's Known on This Subject The pediatric prenatal visit is an opportunity to deliver anticipatory guidance and to gather family information. Despite evidence indicating that pediatric prenatal visits enhance outcomes like immunization rates, few expectant parents receive this service­especially in low-income and BIPOC populations.What This Study Adds Even after recent joint AAP and ACOG guidelines recommending the pediatric prenatal visit, it appears that awareness among obstetrics providers remains low. Disseminating information about existing evidence-based guidelines to patients and providers could increase PPV awareness, reduce disparities in its utilization, and improve health outcomes for mothers and children.

Impact of the Rochester LARC Initiative on adolescents' utilization of long-acting reversible contraception.

BACKGROUND: Preventing unintended teen pregnancy is a national public health priority, and increasing access to long-acting reversible contraception is part of the recommended strategy for the achievement of this goal. Nevertheless, adolescent long-acting reversible contraceptive use across the nation has remained low, even after national and state-level programs increased coverage for no-cost contraception. One persistent barrier is misinformation about the safety, efficacy, and availability of long-acting reversible contraception for teens. To overcome this barrier, the Hoekelman Center, in collaboration with multiple partners, designed and implemented a community health intervention. The Greater Rochester LARC Initiative disseminated accurate information about contraceptive options with a focus on long-acting reversible methods by delivering interactive lunch-and-learn talks throughout the Greater Rochester, NY area. Audiences included both healthcare providers and adults who work with adolescents in nonmedical community-based organizations. OBJECTIVE: The primary purpose of this study was to evaluate the community-level impact of the Greater Rochester LARC Initiative on adolescent long-acting reversible contraception use. STUDY DESIGN: Our evaluation design was pre-post with a nonrandomized control group. We used publicly available Youth Risk Behavior Surveillance System data from the years 2013, 2015, and 2017 for our intervention site of Rochester, NY, New York City, New York State, and the United States overall. These years cover the time before and after the intervention began in 2014. We used z-statistics in investigating the hypothesis that long-acting reversible contraception use increased more in Rochester than in the comparison populations. RESULTS: Between 2013 and 2017, long-acting reversible contraception use in Rochester rose from 4-24% of sexually active female high school students (P<.0001). Over the same period, long-acting reversible contraception use in New York State rose from 1.5-4.8%, and in New York City long-acting reversible contraception use rose from 2.7-5.3%. In the United States overall, long-acting reversible contraception use rose from 1.8-5.3%. Thus, the increase in long-acting reversible contraception use in Rochester was larger than the secular trend in the control groups (P<.0001). CONCLUSION: Adolescent long-acting reversible contraceptive use increased significantly more in Rochester than in the nation as a whole. This finding is consistent with a substantial positive impact of the Greater Rochester LARC Initiative, which implies that similar interventions could be useful complements to unintended teen pregnancy prevention programs elsewhere and might be helpful more generally for the diffusion of evidence-based health-improvement practices.