RT Journal Article
SR Electronic
T1 Translating Team-Based Breastfeeding Support into Primary Care Practice
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 818
OP 826
DO 10.3122/jabfm.2019.06.190118
VO 32
IS 6
A1 Witt, Ann M.
A1 Witt, Rachel
A1 Lasko, Lauren
A1 Flocke, Sue
YR 2019
UL http://www.jabfm.org/content/32/6/818.abstract
AB Background: Team-based care facilitates efficient, evidence-based, patient-centered practice. An outpatient, integrated lactation consultant (LC) and primary care provider (PCP) model improves breastfeeding support, yet practices need assistance with implementation.Method: Based on experience with team-based breastfeeding support at a suburban practice serving mainly well-educated and privately insured families, we constructed and piloted a 6-step needs assessment that informed implementation of the model at a federally qualified health center (FQHC). Practice assessment included baseline data collection of practice newborn volume, breastfeeding intent, breastfeeding rates, provider survey, and financial variables. Postimplementation outcome measurements included provider satisfaction and visit volume.Results: Analysis using newborn volume, breastfeeding intent, and average insurance reimbursement enabled business calculation, which estimated additional 400 visits per year and revenue to cover staff training costs. The baseline provider survey (n = 20) assessed knowledge, practice resources, and barriers. The main barriers identified to providing lactation support were “not enough time” (80%) and patients “not receiving adequate help” (80%) with 58% noting “inadequate LC staffing at the clinic.” After team-based LC/PCP implementation, monthly lactation visit volume doubled. Provider postintervention assessment surveys (n = 20) demonstrated a positive response with providers reporting a perception of “providing better breastfeeding support” (100%) and that “patients had a positive breastfeeding support experience” (84%).Conclusion: Team-based LC and PCP health care is a promising approach for delivering efficient, patient-centered, face-to-face counseling and support. Practice assessment informs financial feasibility and confirms provider interest in change. An integrated LC/PCP model can be implemented in a FQHC while enhancing patient breastfeeding support and provider satisfaction.