EPIC EPIC Breastfeeding Breastfeeding
ProgramProgram
Breastfeeding Education
®
EPIC EPIC
Educating Physicians and Practices In Educating Physicians and Practices In Their CommunityTheir Community
Began in 2007Began in 2007 Peer-to-Peer Physician Breastfeeding Peer-to-Peer Physician Breastfeeding
Education Education Patterned after the EPIC Patterned after the EPIC
Immunization ProgramImmunization Program EPIC Breastfeeding Program hopes to EPIC Breastfeeding Program hopes to
mirror it’s success mirror it’s success
®
EPIC BreastfeedingEPIC BreastfeedingProgram PartnersProgram Partners
Georgia Department of Public Health Georgia Department of Public Health Georgia Chapter –American Academy Georgia Chapter –American Academy
of Pediatricsof Pediatrics Georgia Ob/Gyn SocietyGeorgia Ob/Gyn Society Georgia Academy of Family PhysiciansGeorgia Academy of Family Physicians Centers for Disease Control and Centers for Disease Control and
PreventionPrevention
Goals of EPIC Goals of EPIC Breastfeeding ProgramBreastfeeding Program
Educate physicians & their office staff on Educate physicians & their office staff on breastfeedingbreastfeeding
Give reasons why physicians play a critical roleGive reasons why physicians play a critical role Teach evidence - based standards on how to Teach evidence - based standards on how to
encourage, promote and support breastfeedingencourage, promote and support breastfeeding How to access lactation and support services How to access lactation and support services
in the communityin the community How to access patient education resourcesHow to access patient education resources Inform physicians of WIC services for Inform physicians of WIC services for
breastfeeding mothersbreastfeeding mothers
CDC Breastfeeding CDC Breastfeeding Report CardReport Card
Georgia 2007 2009 2010 2012 2013 2014
Breastfeeding Initiation
68.2% 62.5% 62.8% 70.9% 68.2% 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% 12.9% 6.2% 14.5%
Baby Friendly Hospitals
0 0 0 0 0 3
Why is educating Why is educating physicians on physicians on
breastfeeding important?breastfeeding important? ““[women] typically receive minimal advice [women] typically receive minimal advice
about breastfeeding from a physician.” about breastfeeding from a physician.” Freed et alFreed et al
““Physicians lack the necessary clinical skills Physicians lack the necessary clinical skills to provide lactation management” to provide lactation management” Taveras et alTaveras et al..
““Pediatricians are ideally situated to positively Pediatricians are ideally situated to positively influence the breastfeeding experiences of the influence the breastfeeding experiences of the mother and young infant.” mother and young infant.” Hillenbrand et alHillenbrand et al..
Challenges for Challenges for PhysiciansPhysicians
Not aware of benefits/managementNot aware of benefits/management Lack of timeLack of time Concerns about reimbursementConcerns about reimbursement Not comfortable examining breastsNot comfortable examining breasts No knowledge of community No knowledge of community
resourcesresources
Breastfeeding Advisory Breastfeeding Advisory GroupGroup
Eight membersEight members Meet quarterlyMeet quarterly Develop the curriculumDevelop the curriculum Annual updates to curriculumAnnual updates to curriculum Develop additional programs as needed Develop additional programs as needed Provide expert resourceProvide expert resource
EPIC TrainersEPIC Trainers
Physicians, Nurses, Dieticians & Lactation Physicians, Nurses, Dieticians & Lactation ConsultantsConsultants Must be skilled with breastfeeding managementMust be skilled with breastfeeding management Complete a train the trainer education moduleComplete a train the trainer education module Can be done with group or individualCan be done with group or individual Covers curriculum, set-up, maintenance of equipment and other Covers curriculum, set-up, maintenance of equipment and other
logisticslogistics
Physicians and a lactation specialist are a team Physicians and a lactation specialist are a team and are paired to deliver the programand are paired to deliver the program
Trainers meet twice a year with the EPIC directorTrainers meet twice a year with the EPIC director Trainers receive feedback and evaluations of their performanceTrainers receive feedback and evaluations of their performance Discuss any updates and offer suggestions for curriculum changesDiscuss any updates and offer suggestions for curriculum changes
Trainers are given modest stipend and travel Trainers are given modest stipend and travel reimbursementreimbursement
EPIC ProgramEPIC Program One hour EPIC Breastfeeding Program One hour EPIC Breastfeeding Program Delivered through PowerPoint Presentation Delivered through PowerPoint Presentation
with scriptwith script Presented inPresented in
Doctors officeDoctors office HospitalsHospitals Residencies Residencies Health Departments/WIC Health Departments/WIC
Goal is 6 programs a monthGoal is 6 programs a month Resource materials are left behind for the office Resource materials are left behind for the office
to encourage, promote & support breastfeedingto encourage, promote & support breastfeeding
ResourcesResources
Each office or program receives Each office or program receives breastfeeding resourcesbreastfeeding resources
BooksBooks HandoutsHandouts Coding informationCoding information WIC informationWIC information List of community List of community
resourcesresources
Target CountiesTarget Counties
Bibb Bibb LaurensLaurens RichmondRichmond ClaytonClayton DeKalbDeKalb FultonFulton CobbCobb ThomasThomas GwinnettGwinnett MuscogeeMuscogee ChathamChatham
Marketing our ProgramMarketing our Program
GA AAP Board meetingsGA AAP Board meetings BlastfaxesBlastfaxes Exhibiting at conferencesExhibiting at conferences Send out mailings to previous program Send out mailings to previous program
recipients to take a different programrecipients to take a different program Trainers and Advisory members encourage Trainers and Advisory members encourage
programsprograms Close ties with the WIC and Health Close ties with the WIC and Health
DepartmentsDepartments Word of MouthWord of Mouth
EvaluationEvaluation Pre-program surveyPre-program survey
Assessing physician knowledge and practicesAssessing physician knowledge and practices Program surveyProgram survey
Participant evaluation formParticipant evaluation form Evaluate curriculumEvaluate curriculum Evaluate trainer effectiveness Evaluate trainer effectiveness Seek areas of interestSeek areas of interest
Post- program survey (60 day F/U)Post- program survey (60 day F/U) Access program quality and contentAccess program quality and content Access knowledge gainedAccess knowledge gained Changes in practice behaviorChanges in practice behavior
EPIC Breastfeeding EPIC Breastfeeding ProgramsPrograms
““Breastfeeding Fundamentals”Breastfeeding Fundamentals”
““Supporting Breastfeeding in the Supporting Breastfeeding in the Hospital Setting”Hospital Setting”
““Advanced Breastfeeding Support”Advanced Breastfeeding Support”
®
Breastfeeding Breastfeeding FundamentalsFundamentals
Challenges for PhysiciansChallenges for Physicians Realistic expectationsRealistic expectations Racial disparitiesRacial disparities
Benefits of breastfeedingBenefits of breastfeeding LatchLatch
PositioningPositioning Milk transferMilk transfer
FundamentalsFundamentals
Breastfeeding at deliveryBreastfeeding at delivery Prenatal visit (emphasis on the OB’s Prenatal visit (emphasis on the OB’s
role)role) Postpartum routinePostpartum routine
Most common problemsMost common problems Sore nipplesSore nipples MastitisMastitis Maternal emotionsMaternal emotions MedicationsMedications
FundamentalsFundamentals
Hot TopicsHot Topics Co-sleepingCo-sleeping Milk sharingMilk sharing PacifiersPacifiers SupplementingSupplementing ContraceptionContraception Starting solidsStarting solids
QuestionsQuestions
Supporting Supporting Breastfeeding in the Breastfeeding in the
HospitalHospital Benefits of breastfeedingBenefits of breastfeeding Obstacles to breastfeedingObstacles to breastfeeding
Baby FriendlyBaby Friendly 10 steps10 steps PolicyPolicy Joint commission and mPINC scoresJoint commission and mPINC scores
After deliveryAfter delivery Skin to skinSkin to skin Exclusive breastfeedingExclusive breastfeeding DocumentationDocumentation
Hospital ProgramHospital Program Separation of mom and babySeparation of mom and baby
Pumping/hand expressionPumping/hand expression Kangaroo Care/NICUKangaroo Care/NICU
BarriersBarriers Discharge bagsDischarge bags Follow-up and supportFollow-up and support
WICWIC Food packagesFood packages Services for breastfeeding mothersServices for breastfeeding mothers
Community ResourcesCommunity Resources
Advanced Breastfeeding Advanced Breastfeeding SupportSupport
How do you know if a mother is producing How do you know if a mother is producing enough milk?enough milk? Breast changesBreast changes Urine and stool outputUrine and stool output
How can a mother increase her milk supply?How can a mother increase her milk supply? Evaluating a feedingEvaluating a feeding Pumping/hand expressionPumping/hand expression Galactogues/medicationsGalactogues/medications
What can mothers do to prevent or treat sore What can mothers do to prevent or treat sore nipples?nipples? LATCHLATCH EngorgementEngorgement Nipples problemsNipples problems
Advanced ProgramAdvanced Program When supplements are indicated, how does a When supplements are indicated, how does a
mother supplement without interfering with mother supplement without interfering with breastfeeding?breastfeeding? Maternal issuesMaternal issues Infant factorsInfant factors When to supplementWhen to supplement
WhenWhen HowHow MethodsMethods
How does the pre-term infant differ in their ability How does the pre-term infant differ in their ability to breastfeed?to breastfeed? Define pre-term infantDefine pre-term infant Feeding issuesFeeding issues
ResultsResults
548 programs548 programs 1,590 physicians trained1,590 physicians trained 24.3% are physicians24.3% are physicians 6,889 total trained6,889 total trained 29% held in focus counties29% held in focus counties 99.3% of practices would recommend 99.3% of practices would recommend
the training to other physiciansthe training to other physicians
Future ideas of EPIC®Future ideas of EPIC®
Three hour hospital curriculumThree hour hospital curriculum NICU curriculumNICU curriculum Infant feeding curriculumInfant feeding curriculum More emphasis on OB’s and More emphasis on OB’s and
breastfeeding support/WIC referralsbreastfeeding support/WIC referrals Need more physician data on Need more physician data on
breastfeeding ratesbreastfeeding rates Working with businesses to set up Working with businesses to set up
lactation roomslactation rooms
Questions?Questions?