Assessing the Efficacy of a Breastfeeding-Friendly Quality Improvement Project in a Large Federally Qualified Health Center Network.

BACKGROUND: Provider attitudes can influence breastfeeding decision making, initiation, and duration, although much of this research has suffered from a "hospital-limited view." OBJECTIVES: This study aimed to evaluate the effect of a Breastfeeding-Friendly Initiative (BFI) on knowledge and attitudes of providers and staff, as well as breastfeeding rates of patients within a large Federally Qualified Health Center network with no lactation consultants on staff. METHODS: We evaluated breastfeeding rates before and throughout the BFI. In addition, surveys of 136 primary care providers and staff before and after they were exposed to a breastfeeding education module were assessed to measure changes in breastfeeding knowledge and attitudes. RESULTS: Breastfeeding initiation and duration improved over the course of the BFI, with mean breastfeeding duration increasing by nearly 1 month following the education module compared with baseline rates (P = .01). Following participation in the breastfeeding education module, we observed a statistically significant improvement in provider and staff knowledge (P < .01) and attitudes (P < .01). These improvements were consistent across employment type, gender, geography, and personal experience as a parent. CONCLUSION: Implementing a BFI in a large multispecialty primary care network was found to improve breastfeeding initiation and duration up to 1 year, with a further increase in breastfeeding duration of 1 month following a 45-minute staff education module. After exposure to this module, health care providers and staff across our network improved in breastfeeding knowledge and attitudes. Given that expectant and new mothers regularly come into contact with staff and providers in primary care, sound knowledge and positive attitudes toward breastfeeding appear to have had a favorable effect on mothers that correlates with improved breastfeeding duration.

Developing and implementing a pain management benchmark.

For most patients, pain is an inevitable part of the cancer journey. Pain may be acute or chronic, it may be related to the disease process or to treatments such as surgery, radiotherapy or chemotherapy. For 80-90 per cent of patients with cancer, effective pain relief could be attained using the analgesic guidelines outlined by the World Health Organization (1996). However, in routine practice this is not achieved (Portenoy and Lesage, 1999), which highlights the need to review and improve practice continuously.