Publications

Objectives To evaluate the impact of counseling regarding the maternal health effects of lactation on pregnant women's intentions to breastfeed. Methods Women seeking prenatal care at an urban university hospital completed surveys before and after receiving a 5-min counseling intervention regarding the maternal health effects of breastfeeding. The counseling was delivered by student volunteers using a script and one-page infographic. Participants were asked the likelihood that breastfeeding affects maternal risk of multiple chronic conditions using 7-point Likert scales. We compared pre/post changes in individual item responses and a summary score of knowledge of the maternal health benefits of lactation (MHBL) using paired t tests. Multivariable logistic regression was used to examine the impact of increases in knowledge of MHBL on participants' intentions to breastfeed. Results The average age of the 65 participants was 24 ± 6 years. Most (72 %) were African-American and few (9 %) had college degrees. Half (50 %) had previously given birth, but few (21 %) had previously breastfed. Before counseling, few were aware of any benefits of lactation for maternal health. After counseling, knowledge of MHBL increased (mean knowledge score improved from 19/35 to 26/35, p < 0.001). Improvement in MHBL knowledge score was associated with increased intention to try breastfeeding (aOR 1.20, 95 % CI 1.02-1.42), of wanting to breastfeed (aOR 1.45, 95 % CI 1.13-1.86), and feeling that breastfeeding is important (aOR 1.21, 95 % CI 1.03-1.42). Conclusions for Practice Brief structured counseling regarding the effects of lactation on maternal health can increase awareness of the maternal health benefits of breastfeeding and strengthen pregnant women's intentions to breastfeed.

BACKGROUND

Improving the safety of prescribed opioids in clinical settings is a national priority. While co-prescribing naloxone is increasingly recommended, there is little understanding of the optimal way to implement this practice.

METHODS

We developed and delivered an academic detailing intervention to 40 randomly selected opioid-prescribing primary care providers in San Francisco from February to May 2015. Process outcomes were tracked and included provider demographics, number and type of contact attempts, reason for refusal (if applicable), name of detailer, duration of intervention, topics covered, provider concerns, and follow-up plan. Outcome evaluation included changes in the rate of naloxone prescriptions 4 months before and after academic detailing by provider based on de-identified Medi-Cal claims data. Using a difference-in-differences approach, we developed a negative binomial regression model to compare changes in naloxone prescribing to Medi-Cal patients between providers that did and did not receive the intervention.

RESULTS

Eighty-three percent of 48 providers contacted accepted the intervention after a mean of 2.6 contacts. Detailing lasted a mean of 28 minutes (range 5-60 minutes) and most frequently covered indications for naloxone, examples of naloxone prescriptions, language to use with patients, and pharmacy outreach. Those who received the academic detailing had a significantly greater increase in naloxone prescriptions compared to those who did not receive the intervention (IRR=11.0, 95%CI=1.8-67.8, P=.010).

CONCLUSIONS

Academic detailing addressing opioid safety and naloxone prescribing was well-received by primary care providers and associated with an increase in naloxone prescriptions filled by Medi-Cal patients.