ABSTRACT
Objective:
There are gaps in receipt of maternal preventive services in the interconception period. Yet
mother-
infant dyads have frequent
health care visits.
Health systems have opportunities to better capitalize on existing visits to
address dyad
needs, but this possibility has not been fully explored.
Methods:
In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing
parents or
infants after
preterm birth. We conducted snowball sampling from teams in
pediatrics,
obstetrics, and
family medicine at two geographically adjacent
health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across
adult and
infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach.
Results:
We interviewed 24
physicians,
nurses,
midwives, and
social workers (March-November 2021). Participants identified barriers to integrated care including infrequent
communication between clinical teams, which was generalizable to care of the birthing
parent or
infant as individuals, and additional barriers related to
privacy,
credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and
procedures currently used in their practices, including
electronic health record tools for
communication, dedicated
roles to support
communication or navigation, centralized information on
resources for dyad care,
referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect
face-to-
face about
shared patients or
families.
Conclusions:
Clinicians believe existing
health care structures and processes can be adapted to
address current substantial barriers to integrated dyad care.