2. DISTRICT AND CENTERING CATCHMENT AREA
W are
Burke
C linc h
H all
Laurens
Early
Lee
Bulloch
Floyd
W ayne
C harlton
Fulton
Long
C offee
W orth
Em anuel
Polk
Screv en
D odge
Troup
C arroll
D ecatur
C am den
Bryan
Gr ady
H arris
D ooly
C obb
Gly nn
Brooks
W ilk es
C olquitt
Liber ty
Thom as
Appling
Gilm er
Jones
Bartow
R abun
Irw in
Sum ter
Echols
Fannin
Tift
C ow eta
Telfair
W alk er
U nion
M acon
M itchell
Tay lor
Low ndes
Elbert
Tattna ll
Berrien
W ashington
Talbot
Bibb
H ancock
Baker
Gr eene
Jasper
Stew art
M onroe
U pson
W ilc ox
C risp
Pierce
Pike
Brantley
M arion
H enry
Jefferso n
H art
Tw iggs
C lay
Gor don
Gw inn ett
Putnam
M urray
H eard
C ook
M iller
Toom bs
R andolph
Bacon
M organ
Terr ell
Effingham
W alton
W ilk inson Jenkins
M cIntosh
C herokee
H ouston
C hatham
M
eriwether
Jacks on
Turner
Banks
Paulding
Oglethorpe
Atkinson
Johnson
W hite
Pulaski
C alhoun
Baldw in
W arren
Linc oln
N ew to n
Lum pkin
R ichm ond
M adison
W heeler
C raw ford
C olum bia
D e K alb
Butts
C andler
Frank lin
Evans
H aralson
D ougherty
Lam ar
Lanier
C hattooga
Pickens
Ben H ill
Fors yth
Jeff D avis
Tow ns
W
hitfield
D aw son
Seminole
D ouglas
Bleckley
Oc onee
Schley
Habersham
Fay ette
Barrow
Spalding
C atoos a
Treutlen
M usc ogee
Mont-
gomery
Taliaferro
Quitm an
Glas cock
Chatta-hoochee
Clayton
Rockdale
Ste p hens
McDuffie
Clark e
Pea ch
W ebste r
Dad e
8-1
9-2
7
5-1
9-3
5-2
6
10
2
1-2
1-1
3-1
4
3-4
3-2 3-5
9-1
3-3
8-2
Georgia Public H ealth D istricts
1-1 N o rth w e st (Ro m e)
1-2 N o rth G A (D a lto n )
2 N o rth (Ga in esville)
3-1 C o bb -Do u g la s
3-2 F u lto n
3-3 C la yto n
3-4 E a st M et ro
3-5 D e Ka lb
4 L a Gra n g e
5-1 S o u th C en tr al (Du b lin )
5-2 N o rth C e nt ral (M a c o n )
6 E a st C e n tra l (A u g usta )
7 W e st C e ntr al (C olu m b u s)
8-1 S o u th (V a ld o sta )
8-2 S o u thw e st (Alb an y)
9-1 C o asta l (Sa va n n ah )
9-2 S o u the a st (W a yc ro ss)
1 0 N o rth ea st (A th e ns)
3. Problem Being Addressed
• Barriers to early access to prenatal care for low-income women
▫ African-American women
14 county predominantly rural district, many counties no obstetrician
Loss of three high-volume OB/GYN Medicaid providers in Dougherty, 2008
Dougherty County: 64% African-American
Dougherty County accounts for a third of the district’s population
Presumptive eligibility for pregnancy Medicaid not accepted by most
obstetricians in Dougherty County
▫ Hispanic women
The District’s southernmost counties are agricultural hubs
Colquitt County’s Hispanic population estimated at 14% - probably
significantly under-estimated due to a large number of undocumented
Hispanic farm workers
Transportation issues
June, 2010 – prenatal care for undocumented low-income Hispanic no longer
financed by the Babies Born Healthy (BBH) Program
4. What Is Centering?
• National model of group prenatal care
• Groups of 6-8 women whose due dates are in the same
month
• Nine two-hour sessions
• Individual assessments
• Facilitated discussions
• Sessions are fun and interactive
• Time for socializing and refreshments
• Sessions are held at the same intervals as traditional
prenatal care
• Monthly until 28 weeks gestation
• Every two weeks until 36 weeks gestation
5. What Is Centering?
• Support people involved in sessions
• Social Worker co-facilitates sessions
• More experience with depression, domestic violence and other
social issues
• More likely to pick up on non-verbal cues related to some of these
issues
• Patients participate in their prenatal care
• Take their own blood pressure
• Weigh themselves
• Plot and monitor their weight
• Wheel out their gestational age
6. Maternal Characteristics: Medical
Dougherty County Health Department
• Slightly less than 3% had a prior preterm birth
• 30% were treated for sexually transmitted
infections
• 18% reported tobacco use and 15% tested
positive for marijuana
• Slightly more than a third were anemic
• 18% were treated for asymptomatic bacteriuria
• 5.5% reported depression
• 4.5% had sickle cell trait
• 6% developed gestational diabetes
7. Maternal Characteristics: Medical
Ellenton Clinic
• 12% treated for sexually transmitted
infections
• None reported tobacco use or tested
positive for marijuana
• None reported a history of asthma
• Over half were anemic
• 16% developed gestational diabetes
• 4% reported depression
16. CenteringPregnancy®:
Expanding Services Through
the Use of Telemedicine
* Better coordination of services
* Easier access to subspecialists:
• Maternal –Fetal Medicine
• Cardiologist
• Mental and Behavioral Health
• Dermatologist
17. Access to telemedicine allows
ultrasounds and Maternal
Fetal Medicine consults to be
done on-site
18. Through a partnership with Women’s Telehealth in Atlanta, Dr. Anne
Patterson is introduced to each Centering group and included in
facilitated discussions in sessions on pre-term labor and gestational
diabetes via the telemedicine cart.
Program purpose: To improve access to care and perinatal outcomes in low income African-American and Hispanic women in Southwest Georgia
T
The five year rolling data. Baseline is the data before the start of the program- this is the data we were looking at to determine needs.
PTB=births before 37 completed gestational weeks, Nationally the preterm birth rate was 12.8% in 2006 and it was 18.4% for Blacks in 2006*LBW %= % of births <2500 grams
N=136 patients DoughertyN= 78, but if add in patient who had inevitable SAB (only attended one session) and maintain pregnancy then PTB 10.1%
