A Framework for Coordination between Obstetric and Pediatric Providers in Public Health Emergencies: Lessons Learned from the Zika Outbreak in the United States, 2015 to 2017.

Emergency response to emerging threats with the potential for vertical transmission, such as the 2015 to 2017 response to Zika virus, presents unique clinical challenges that underscore the need for better communication and care coordination between obstetric and pediatric providers to promote optimal health for women and infants. Published guidelines for routine maternal-infant care during the perinatal period, and models for transitions of care in various health care settings are available, but no broad framework has addressed coordinated multidisciplinary care of the maternal-infant dyad during emergency response. We present a novel framework and strategies to improve care coordination and communication during an emergency response. The proposed framework includes (1) identification and collection of critical information to inform care, (2) key health care touchpoints for the maternal-infant dyad, and (3) primary pathways of communication and modes of transfer across touchpoints, as well as practical strategies. This framework and associated strategies can be modified to address the care coordination needs of pregnant women and their infants with possible exposure to other emerging infectious and noninfectious congenital threats that may require long-term, multidisciplinary management. KEY POINTS: · Emerging congential threats present unique coordination challenges for obstetric and pediatric clinicians during emergency response.. · We present a framework to help coodinate care of pregnant women/infants exposed to congenital threats.. · The framework identifies critical information to inform care, health care touchpoints, and communication/information transfer pathways..

Efforts to Improve Immunization Coverage during Pregnancy among Ob-Gyns.

BACKGROUND: Influenza and Tdap vaccines are vital factors for improving maternal and neonatal health outcomes. METHODS: A prospective, longitudinal study was conducted to determine whether the American College of Obstetricians and Gynecologists' (ACOG's) efforts to increase ob-gyn use of their immunization toolkits and vaccination administration were successful. Pre- and postintervention questionnaires were mailed to a random sample of 1,500 ACOG members between August 2012 and July 2015. RESULTS: Significantly more postintervention survey ob-gyns reported that they received the immunization toolkits than preintervention survey ob-gyns (84.5% versus 67.0%, p < .001). The large majority of ob-gyns from both surveys (76.9% versus 78.9%) reported that they offered or planned to offer influenza vaccinations to their patients for the 2012-2013 and 2014-2015 flu seasons. Postintervention survey respondents were significantly more likely than preintervention survey participants to report that they routinely offer Tdap vaccinations to all patients during pregnancy (76.8% versus 59.3%, p < .001). CONCLUSION: ACOG's efforts to improve ob-gyn use of immunization toolkits and vaccine administration appear to have been successful in several ways. ACOG's toolkits are an example of an effective intervention to overcome barriers to offering vaccines and help improve influenza and Tdap immunization coverage for pregnant women.

Patient perceptions of obstetrician-gynecologists' practices related to HIV testing.

OBJECTIVES: The objectives of this study were to (1) determine the percentage of obstetrician-gynecologists' patients who have been tested for HIV; (2) examine patient attitudes about HIV testing and patients' knowledge about their own risk status; (3) determine primary reasons patients decline an HIV test; and (4) learn patient recall of how their obstetrician-gynecologists approach the topic of HIV testing. METHOD: Survey packets were mailed to each of 687 obstetrician-gynecologists who are members of the Collaborative Ambulatory Research Network (CARN) to distribute to their patients. Data are reported from 851 patient respondents (297 pregnant and 554 non-pregnant), and were analyzed utilizing independent samples t-tests, chi2 analysis, and linear regression. RESULTS: Two-thirds of respondents (65%/n = 534) reported having been tested for HIV at some point, although the majority (72%) did not recall that their current obstetrician-gynecologist had recommended HIV testing. Among pregnant respondents specifically, 61% did not recall that their current obstetrician-gynecologist had recommended HIV testing, although 82% reported having had an HIV test at some point and 71% stated they had received their most recent HIV test results from their obstetrician-gynecologist during their current pregnancy. Age, race, and pregnancy status were linked to likelihood of patient recall of receiving an HIV testing recommendation from their obstetrician-gynecologist; with young, pregnant, Hispanic, and African-American patients most likely to recall a test recommendation. Perceived low risk was the primary reason given for declining an HIV test. Only 2% of respondents considered themselves high-risk for HIV despite almost half of the sample reporting having had unprotected sex at some point with more than one partner. CONCLUSIONS: Many patients did not recall that their obstetrician-gynecologist had ever recommended HIV testing, although the majority had been tested. Efforts should be made to increase communication between obstetrician-gynecologists and their patients related to HIV risk status and HIV testing.

Obstetrician gynecologists' knowledge and practice regarding human immunodeficiency virus screening.

OBJECTIVE: To gather more information regarding prenatal human immunodeficiency virus (HIV) testing by examining the practice patterns of obstetrician-gynecologists. METHODS: Survey questionnaires were sent to 1,032 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in practice. Questionnaires included inquiries about obstetrician-gynecologist characteristics, testing practices, and knowledge regarding HIV screening. RESULTS: A total of 582 surveys (56%) were returned. We found that 1) most (97%) obstetrician-gynecologists reported recommending HIV testing to all of their pregnant patients, 2) almost half (48%) of the physicians reported using the opt-out approach to prenatal HIV testing, and 3) respondents were sometimes unaware of whether their state requires recommending HIV testing during pregnancy. CONCLUSION: The finding that some obstetrician-gynecologists are unaware of their state regulations regarding prenatal HIV testing suggests that they would benefit from an increased awareness of state laws and regulations and having timely access to these requirements. The finding that most obstetrician-gynecologists offer HIV testing to all of their pregnant patients is consistent with the literature regarding prenatal HIV screening and with federal and national recommendations. However, study results also suggest that obstetrician-gynecologists may benefit from additional information to increase knowledge and strengthen perinatal HIV testing practice patterns. LEVEL OF EVIDENCE: III.

What factors influence obstetrician-gynecologists to follow recommended HIV screening and testing guidelines?

BACKGROUND: The purpose of this study was to determine what factors may influence obstetrician-gynecologists' HIV testing practices and to learn more about obstetrician-gynecologists' current HIV screening and testing practices. METHODS: Survey questionnaires were sent to 1200 American College of Obstetricians and Gynecologists (the College) Fellows and Junior Fellows in practice between October 2009 and January 2010. Four hundred of the recipients were members of the Collaborative Ambulatory Research Network (CARN), and 800 recipients were randomly selected from the ACOG Fellows and Junior Fellows in practice. RESULTS: The survey response rate was 62.0% (248 of 400) for CARN and 31.1% (249 of 800) for non-CARN. Nearly 100% (99.7%) of the study sample report recommending HIV testing to all pregnant women at least once during each pregnancy, while reported rates for repeat testing in the third trimester remain low (20.1% for all patients and 42.6% for high-risk patients). Two thirds (66.0%) of respondents recommend labor and delivery testing to women with unknown or undocumented HIV status. Fewer than 22.0% of respondents report routinely recommending HIV screening to all non-pregnant women, citing a low-risk population as the most common reason. State laws and regulations have only moderate influence on obstetrician-gynecologists' HIV testing practice, as do practice type, location, and setting. CONCLUSIONS: The results of this study suggest that the provider's perception about the patients' risk for being infected as well as practice type and location are important factors influencing an obstetrician-gynecologist's decision to screen a nonpregnant woman for HIV.

What obstetrician-gynecologists think of preconception care.

OBJECTIVES: To describe obstetrician-gynecologists' opinions of preconception care (PCC) and ascertain patient uptake for this service. METHODS: A questionnaire was mailed to 1105 ACOG members in August 2004. RESULTS: There was a 60% response rate. Most physicians think PCC is important (87%) and almost always recommend it to women planning a pregnancy (94%); 54% do so with women who are sexually active. Around a third (34%) thought their patients usually do not plan their pregnancies and 49% said very few pregnant patients came in for PCC. Of those who obtain PCC, they were believed to do so more likely to assure a healthy pregnancy (83%) than because of an elevated risk for birth defects (20%). Of 11 issues presented, cigarette smoking and folic acid supplementation were rated the most important for PCC counseling; exercise and environmental concerns were the least important. CONCLUSIONS: Physicians are willing to provide PCC but few patients are accessing such services.