Return to Main Menu

Perinatal care outreach bridges gap by Susan Thul MUSC Nurse Midwife With three outreach clinics located in the Charleston Tri-county region, the Perinatal Outreach Clinic Program and MUSC Women’s Health is dedicated to providing quality perinatal care to uninsured and underinsured women at risk.   The demographics of the women served changed significantly during the 18 months since the program’s inception. Patients reside primarily in several ethnic pocket areas within Charleston, Berkeley, Dorchester and neighboring Colleton Counties.    The Perinatal Outreach program serves Caucasian (15 percent of patient population), African-American (20 percent), and Hispanic (65 percent) women of childbearing age for who pregnancy represents social, financial and medical challenges.    Thirty percent of enrolled patients receive Medicaid insurance coverage for their pregnancies. Sixty percent are uninsured and the remaining 10 percent are covered by third party insurance carriers.  More than 25 percent of patients present with “rapid repeat” pregnancies; defined as an interconception period of less than 18 months. Pregnancies for these women are typically unplanned and present increased challenges to daily existence. A large portion of this population is within the adolescent age range.    Within key population pocket areas, the Outreach clinics occupy three strategically and distinctly different settings. Each clinic is located in close proximity to government, secular and religious support service locations including WIC and state Health Department clinics. As such, the women enrolled in the outreach initiative employ a one-stop-shopping approach to meet a broad spectrum of health care needs. Clinic locations reflect consideration of the public transportation systems, as well as travel accessibility from outlying rural communities.    The Northwoods office site, located in North Charleston, operates as the “hub” of the outreach program. Outreach patients are also seen at the Health Department in Moncks Corner.   In July, the outreach program formed a partnership with Our Lady of Mercy Outreach on Johns Island. Patients are now seen at the Wellness House Clinic, operated by the OLM outreach.   Core staffing includes a dedicated attending physician, Michael Armstrong, M.D.; three certified nurse midwives, Sarah Buiel, Faye LeBoeuf, and Susan Thul; a nurse case manager; a licensed practical nurse; certified medical assistant; two patient representatives; and a financial counselor. Everyone on staff speaks Spanish and English.   The outreach program’s hallmark focuses on reducing the barriers to adequate perinatal care and strives to provide a consistent standard of care to all women enrolled into the program.   During program development, several key barriers became apparent including financial, cultural, linguistic, educational, and transportation challenges; and for many women, the fear of deportation.   Program interventions were designed to reduce these common barriers while addressing the critical components of cultural competence.  Delivery of care is not limited to physical needs, but includes proactive interventions to address environment, socio-cultural experiences or exposures; lifestyle; maternal-fetal interactions; physiologic responses; and “weathering.”  The women enrolled in the outreach program receive comprehensive prenatal, postpartum, and family planning services with ready access to high risk consultation by maternal fetal medicine specialists.   From a clinical outcome and business model perspective, these focused activities proved extremely successful. During the last 18 months, the program increased its delivery volume by 44 percent, from 400 deliveries in fiscal year 2003 to more than 600 in fiscal year 2005.    The program’s loss rate, or patient transfers, is less than 10 percent among all patients, regardless of insurance coverage. The program doubled its clinical space at the North Charleston clinical site-from 2,000 square feet to more than 5,000 square feet, thus allowing for expansion of services to include ultrasonography, non-stress testing, on site phlebotomy, sexual assault examinations, and group educational offerings.      In tandem with its clinical mission, the outreach program supports resident, medical student and certified nurse midwife student education; often providing a student’s first experience with vulnerable, multicultural women and their families.  Friday, Dec. 9, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.