Collaboration of Health Systems to Address Family Planning and - - PowerPoint PPT Presentation

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Collaboration of Health Systems to Address Family Planning and - - PowerPoint PPT Presentation

Dec 31, 2022 130 likes •451 views

Collaboration of Health Systems to Address Family Planning and Womens Cancer Screening Connie Gayle White, MD, FACOG Senior Deputy Commissioner Jan Chamness Director, Division of Womens Health May 17, 2019 Dr. Jeffrey D. Howard,

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  • Dr. Jeffrey D. Howard, Commissioner

Collaboration of Health Systems to Address Family Planning and Women’s Cancer Screening

Connie Gayle White, MD, FACOG

Senior Deputy Commissioner

Jan Chamness

Director, Division of Women’s Health

May 17, 2019

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Objectives

  • 1. Understand the Family Planning and

Kentucky Women’s Cancer Screening Programs at the Department for Public Health (DPH).

  • 2. Discuss the impact of providing reproductive

health services to vulnerable populations.

  • 3. Discuss how Federally Qualified Health

Centers and look-alike providers can partner with their local health departments or directly with the DPH Division of Women’s Health to increase optimal family spacing, breast and cervical cancer screening and

  • ther reproductive health services across

Kentucky.

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  • KY has approximately 284,530 women ages 13-44 in need of

publicly funded family planning services.

  • LHDs and other sub recipients provided FP services to 47,306

clients in CY 2018.

  • 85% of the clients served were 150% below the federal

poverty level

  • 36% of the clients served were uninsured
  • 21% of the clients were ages <15 – 19 (11% were 17 years
  • ld or younger)
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Breast Cancer Screening:

  • CBE
  • Mammograms
  • MRIs

Follow-up Diagnostics

Increased screening rates reduce breast/cervical morbidity/mortality rates!

Saving Women’s Lives Through Early Detection

Kentucky Women’s Cancer Screening Program

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Cervical Cancer Screening:

  • Pap test
  • HPV test

Follow-up Diagnostics

Case Management Patient Navigation

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  • Estimated # of uninsured women in KY (KWCSP eligible): 53,7658
  • Total # of breast cancers in KY (2012-2016): 147,184
  • Total # of cervical cancers in KY (2012-2016): 1,044
  • Total # of women screened through KWCSP in FY 2018: 5,565
  • Total # of KWCSP clients receiving follow-up care in FY 2018: 600
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The Impact

  • f Providing

Reproductive Health to Vulnerable Populations

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CARLISLE GRAVES FULTON HICKMAN

ROBERTSON

CALLOWAY ROCKCASTLE

Kentucky Percent of Persons Living in Poverty 2017 US Census Estimate US 14.6% KY 18.3%

5.5 - 15.9 16.0 - 23.4 23.5 - 34.9 35.0 - 49.5

At least 1 FQHC or look-alike provider in the county providing WH services. ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀

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Cervical & Breast Cancer Screening- Rarely or never screened populations

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  • Being rarely or never screened is the

major contributing factor to most cervical and breast cancer deaths.

  • Who are the rarely or never screened?
  • Minorities
  • Low socioeconomic status
  • Foreign born, living in the U.S. < 10 yrs.
  • No source of health care

Sources: US Census, BRFSS, National Health Interview Survey, National Center for Health Statistics, CDC

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Partnership with Juniper Health in Lee County An impressive beginning…

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Baseline breast screening rates:

  • 62% (September, 2018)

Current breast screening rates:

  • 73% (January, 2019)

Source: Juniper Health, Inc. data through January 2019.

Patient Navigation Results…

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Optimal Family Spacing

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  • Helping every client have and maintain a

reproductive life plan

  • Providing a wide variety of effective

client-centered contraceptive methods to clients who wish to delay or prevent pregnancy

  • Benefits:
  • Prevent unplanned and potentially

unwanted pregnancies

  • Healthy maternal and child outcomes
  • Allows a woman or couple to achieve

goals

  • Decreases the likelihood of poverty
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Kentucky Teen Birth Rate: Lowest in Recorded History

2008- 55.3 2017- 28.1

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2008 Rate 2011 Rate 2012 Rate 2013 Rate 2014 Rate 2015 Rate 2016 Rate 2017 Rate* Kentucky 55.8 43.13 40.5 38.7 34.5 31.4 30 28.1 Appalachian Counties 62.4 54.7 55.2 50.2 46 42.8 41.1 37.7 Non- Appalachian Counties 52.4 38.8 35.8 34.6 30.4 27.3 26.2 24.8 National Rate 41.6 31.3 29.4 26.6 24.2 22.3 20.3 18.8 KY Data Source: KY Vital Statistics *Preliminary Data

Kentucky Teen Birth Trends

2008, 2011-2017

Per 1000 females ages 15-19

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(Positive Youth Development-centered)

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Family Planning’s Role related to the Substance Abuse Crisis

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2014 2015 2016 2017 2018 Acute Drug Poisoning (overdose) Any Substance 13,934 16,428 18,841 19,975 16,795 Drug Dependence (excluding overdoses) Any Substance 15,309 17,678 20,682 22,700 22,390 Nondependent Abuse of Drugs (excluding

  • verdoses) Any Substance

38,152 44,038 47,388 53,551 59,970

Drug-related Hospitalizations & ER Visits among KY Residents

(Source: KIPRC)

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Family Planning’s Role related to the Substance Abuse Crisis

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In 2014*, nearly 2 out of every 100 women giving birth in Kentucky was diagnosed with Opioid Use Disorder.

*Most recent available data (Source: 2019 DPH NAS Report)

63%

Number of substances

Frequency of Polysubstance Use

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Contraceptive Methods

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Contraceptive methods are tiered from most effective to least effective based on failure rates. Failure rates are directly related to a person’s involvement in using the method. Less than 1 pregnancy per 100 women in a year 6-12 pregnancies per 100 women in a year

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Contraceptive Methods

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Contraceptive methods are tiered from most effective to least effective based on failure rates. Failure rates are directly related to a person’s involvement in using the method. 18 or more pregnancies per 100 women in a year Client choice is very important. What works for one client will not work for others. Clients need education and empowerment to make the right decision for them.

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Potential Partnerships to Increase Women’s Health Services Across Kentucky

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KENTUCKY PUBLIC HEALTH TRANSFORMATION

Working together for an efficient, sustainable and accountable public health system focused on producing better health outcomes for all Kentuckians.

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HOW DID LOCAL HEALTH DEPARTMENTS GET HERE?

Several factors have influenced this transformation but most impactful are:

1.Affordable Care Act 2.Kentucky’s pension crisis

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Fiscal Instability

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CHALLENGES

LHD services are not reflective of community needs

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  • Many LHD are duplicating services already provided by

FQHCs and other agencies in their community

  • Decreased state and federal funding
  • Decreased number of uninsured population

requiring services

  • Pension costs

3

  • Current statutes and regulations

are not in line with current public health landscape

  • Hybrid structure of public health

(state and local governance)

Legislative Issues and Shared Governance

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Fiscal Instability

1

Solutions

LHD services are not reflective of community needs

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Seek partnerships with FQHCs and other agencies who are providing the services to eliminate duplication.

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  • Collaboration, transparency and

trust at all levels and with community partners.

  • Education and accountability with

LBOH and community partners.

Legislative Issues and Shared Governance

Simplify and focus PH model, prevent duplication, share resources and expertise.

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Partnering with the Division of Women’s Health (DWH)

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To date: 27 LHDs representing 47 counties will not be accepting federal funds to provide most women’s health services in FY 2020.

21 LHDs are yet to notify DWH of their intentions.

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Partnering with the Division of Women’s Health

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The DWH anticipates partnering with FQHCs or look-alike providers in counties where LHDs have declined federal funds .

Conversations and preliminary negotiations are in process with seven FQHCs or look-alike providers.

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Partnering with the Division of Women’s Health

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Partnerships may include:

  • Federal funding for women’s

cancer screening and family planning services for uninsured/underinsured clients

  • Patient outreach and

navigation services for women’s cancer screening

Agreements are personalized to the service needs of the communities and ability to provide services

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Partnering with the Division of Women’s Health

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Benita Decker, RN

Family Planning/ Adolescent Health Program Director DPH, Division of Women’s Health

502-564-3236 X4169 Ellen Barnard

KWCSP Program Director DPH, Division of Women’s Health

502-564-3236 X4157

Jan Chamness

Director DPH, Division of Women’s Health

502-564-3236 X4065 Connie Gayle White, MD, FACOG

Senior Deputy Commissioner Department for Public Health

502-564-3970 X4062