EPIC Breastfeeding Program ® EPIC Breastfeeding Program Breastfeeding Education

EPIC Educating Physicians and Practices In Their Community ® Educating Physicians and Practices In Their Community Began in 2007 Peer-to-Peer Physician Breastfeeding Education Patterned after the EPIC Immunization Program EPIC Breastfeeding Program hopes to mirror it’s success

EPIC Breastfeeding Program Partners Georgia Department of Public Health Georgia Chapter –American Academy of Pediatrics Georgia Ob/Gyn Society Georgia Academy of Family Physicians Centers for Disease Control and Prevention

Goals of EPIC Breastfeeding Program Educate physicians & their office staff on breastfeeding Give reasons why physicians play a critical role Teach evidence - based standards on how to encourage, promote and support breastfeeding How to access lactation and support services in the community How to access patient education resources Inform physicians of WIC services for breastfeeding mothers

CDC Breastfeeding Report Card Georgia 2007 2009 2010 2012 2013 2014 Breastfeeding Initiation 68.2% 62.5% 62.8% 70.9% 70.3% Breastfeeding @ 6 months 38% 36.4% 33.5% 40.8% 31.8% 40.1% Breastfeeding @ 12 months 16.8% 18.1% 17.9% 17.6% 12.9% 20.7% Exclusive Breastfeeding @ 6 months 11% 14.8% 9.7% 6.2% 14.5% Baby Friendly Hospitals 3 CDC started the MPINC project – Maternity Practices in Infant Nutrition and Care in 2007 to monitor how hospitals are doing. They monitor skin-to skin, supplementing, breastfeeding assistance, separation of mother and baby, staff training, documentation, and discharge care. You get a score. Georgia’s score in 2007 was 56 with a ranking of 46. In 2013, Georgia’s score was 69 and with a ranking of 45.

Why is educating physicians on breastfeeding important? “[women] typically receive minimal advice about breastfeeding from a physician.” Freed et al “Physicians lack the necessary clinical skills to provide lactation management” Taveras et al. “Pediatricians are ideally situated to positively influence the breastfeeding experiences of the mother and young infant.” Hillenbrand et al.

Challenges for Physicians Not aware of benefits/management Lack of time Concerns about reimbursement Not comfortable examining breasts No knowledge of community resources Make sure that OB know that they need to know about breastfeeding and how to help manage breastfeeding problems and help a mother with her milk supply. The pediatrician needs to be able to observe a baby breastfeeding to watch for milk transfer.

Breastfeeding Advisory Group Eight members Meet quarterly Develop the curriculum Annual updates to curriculum Develop additional programs as needed Provide expert resource Pediatric chair, another pediatrician, an OB, family physician, WIC breastfeeding coordinator, state breastfeeding coordinator, CDC representative, and a breastfeeding expert. We have since added Tammy Fuller and some in this room. They also are brought together and informed of anything going on with breastfeeding such as the Surgeon Generals Call to Action.

EPIC Trainers Physicians, Nurses, Dieticians & Lactation Consultants Must be skilled with breastfeeding management Complete a train the trainer education module Can be done with group or individual Covers curriculum, set-up, maintenance of equipment and other logistics Physicians and a lactation specialist are a team and are paired to deliver the program Trainers meet twice a year with the EPIC director Trainers receive feedback and evaluations of their performance Discuss any updates and offer suggestions for curriculum changes Trainers are given modest stipend and travel reimbursement

EPIC Program Goal is 6 programs a month One hour EPIC Breastfeeding Program Delivered through PowerPoint Presentation with script Presented in Doctors office Hospitals Residencies Health Departments/WIC Goal is 6 programs a month Resource materials are left behind for the office to encourage, promote & support breastfeeding

Resources Each office or program receives breastfeeding resources Books Handouts Coding information WIC information List of community resources

Target Counties Bibb Laurens Richmond Clayton DeKalb Fulton Cobb Thomas Gwinnett Muscogee Chatham Target counties given to us by DHR. We have to have at least 50% of our trainings in these counties and at least one training in each county per year.

Marketing our Program GA AAP Board meetings Blastfaxes Exhibiting at conferences Send out mailings to previous program recipients to take a different program Trainers and Advisory members encourage programs Close ties with the WIC and Health Departments Word of Mouth Started off by informing our members. Exhibit at PEDS, OB’s, Family Physician conferences Emory breastfeeding conference

Evaluation Pre-program survey Program survey Assessing physician knowledge and practices Program survey Participant evaluation form Evaluate curriculum Evaluate trainer effectiveness Seek areas of interest Post- program survey (60 day F/U) Access program quality and content Access knowledge gained Changes in practice behavior We plan on adding breastfeeding rates in physicians offices. We will have follow up survey at 6 months to see if a practice has had an increase in breastfeeding mothers since they took our EPIC training.

EPIC Breastfeeding Programs ® “Breastfeeding Fundamentals” “Supporting Breastfeeding in the Hospital Setting” “Advanced Breastfeeding Support” Future EPICS???? Breastfeeding in the NICU Help improve neonatal outcomes Training for NICU staff in protocols for handling breast milk and how to store. When to start PO feedings Importance of skin to skin Where and how to purchase human milk How to increase fat and protein of human milk –lacto-engineering

Breastfeeding Fundamentals Challenges for Physicians Realistic expectations Racial disparities Benefits of breastfeeding Latch Positioning Milk transfer

Fundamentals Breastfeeding at delivery Most common problems Prenatal visit (emphasis on the OB’s role) Postpartum routine Most common problems Sore nipples Mastitis Maternal emotions Medications Postpartum depression

Fundamentals Hot Topics Questions Co-sleeping Milk sharing Pacifiers Supplementing Contraception Starting solids Questions

Supporting Breastfeeding in the Hospital Benefits of breastfeeding Obstacles to breastfeeding Baby Friendly 10 steps Policy Joint commission and mPINC scores After delivery Skin to skin Exclusive breastfeeding Documentation

Hospital Program Separation of mom and baby Barriers WIC Pumping/hand expression Kangaroo Care/NICU Barriers Discharge bags Follow-up and support WIC Food packages Services for breastfeeding mothers Community Resources

Advanced Breastfeeding Support How do you know if a mother is producing enough milk? Breast changes Urine and stool output How can a mother increase her milk supply? Evaluating a feeding Pumping/hand expression Galactogues/medications What can mothers do to prevent or treat sore nipples? LATCH Engorgement Nipples problems Baby cues are discussed

Advanced Program When supplements are indicated, how does a mother supplement without interfering with breastfeeding? Maternal issues Infant factors When to supplement When How Methods How does the pre-term infant differ in their ability to breastfeed? Define pre-term infant Feeding issues

Results 548 programs 1,590 physicians trained 24.3% are physicians 6,889 total trained 29% held in focus counties 99.3% of practices would recommend the training to other physicians I was able to present our program for ICLA the International Lactation Consultants Association at they annual Breastfeeding confenfernce in San Diego to over 900 people.

Future ideas of EPIC® Three hour hospital curriculum NICU curriculum Infant feeding curriculum More emphasis on OB’s and breastfeeding support/WIC referrals Need more physician data on breastfeeding rates Working with businesses to set up lactation rooms

Questions?