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Access to public health perinatal services varies by community and some areas do not have a standard process in place for sharing patient information between multiple providers. As a result, pregnant women receiving perinatal services from several different providers can be impacted by duplication, inconsistent messaging, missed referrals, missed opportunities to explore social determinants of health, delayed early access to health information and lack of coordinated care.
That’s changing in Fort St. John and Vanderhoof. The two communities have served as prototypes for a seamless perinatal care program for pregnant women and their families. An integrated services model is now being used to better support pregnant women and to provide more in-depth services for vulnerable pregnant women. Depending on their particular needs, expectant women are referred to a variety of programs, including parenting programs, nicotine intervention services, dietician support, mental health and addictions services as well as prenatal classes.
Integrated perinatal services are delivered through a team of health care professionals that include mainly primary care providers and public health staff as well as mental health and addictions service clinicians, dietician, and others. Northern Health practice support coaches and care process coaches work as a bridge between primary care practice and Northern Health services. The team started by investigating the problem. Process journey mapping revealed redundant steps in the perinatal process, while mapping perinatal care work flow identified the best provider for the right context of care. Integrating services could improve women’s early access to prenatal care, services and supports from a multidisciplinary team, optimize opportunities for perinatal intake and determine the best provider for the right context of care.
By improving integration and coordination of perinatal services, the perinatal registry builds women’s knowledge of and earlier access to services and information that help them have a healthier pregnancy and baby. Now, in Fort St. John, a public health nurse initiates prenatal intake, screening, assessment and referral; a prenatal clinic Registered Nurse is a constant and consistent care provider during the prenatal period; and a physician who works on a rotation basis in the prenatal clinic and birthing centre provides full physical examinations and referrals for specialist services. The integrated Fort St. John Prenatal Clinic has assisted with maintaining a high level of perinatal services in a community with one of the highest birthrates per capita during a shortage of physicians. In Vanderhoof, a similar team-based care service is provided without the co-location of services. Ongoing public health nurse follow-up is offered for vulnerable pregnant women and patient information is efficiently shared between primary and acute care staff.
The results are impressive: 100% of all women accessing primary care for prenatal service are registered and connected with a public health nurse and other perinatal services depending on their vulnerabilities. This is an increase of 32% compared to before the new process was implemented. With less duplication of intake, patients are not being repeatedly asked the same questions. Vulnerable pregnant women are put on an evidence-based path that leads to a healthy future for them and their children.
Integrated perinatal services offer patients the right provider for the right context of care. Pregnant women have increased and improved access to a multidisciplinary team. A shared use of the perinatal form (the Perinatal Services BC Antental record) facilitates communication and continuity of care between providers, facilities and patients and also is an efficient use of staff resources because it keeps team members updated on what care their colleagues have provided. For example, this can help when a patient is transferred from prenatal care to the delivery stage, and the doctor delivering the baby can easily refer to detailed pregnancy information about the pregnant patient and better prepare for the birth. There are also efficiencies once the mother and child have been discharged because the shared record helps to keep public health nurses well-linked to those particular patients.
Moving forward, the program’s goals include conducting ongoing quality improvement and program evaluation, expanding the prenatal registry to all Northern Health communities, and implementing and standardizing an integrated perinatal care model in additional communities. Learning outcomes from are being shared across the region as well as at the provincial level with the Provincial Healthy Start Working Group. Work is continuing in Northern Health to standardize the processes related to perinatal care and, in doing so, reducing risk factors and improving quality of care.