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Research Results |
Study Design
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Convenience sample patients and providers of family practice and OB/GYN clinics in Washington State.
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Health providers included office physicians, nurses, PA's.
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Random sample of charts meeting study criteria (women aged 18-45; seen in clinic in last year).
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All surveys & chart reviews confidential; no names recorded.
Sample
As of 7/30/02 six clinics have been recruited to participate in our study. Data has not yet been tabulated for Clinic 6. Demographics about the 6 clinic samples are presented in Table 1.
Table 1. Clinic Samples.
|
Clinic 1 |
Clinic 2 |
Clinic 3 |
Clinic 4 |
Clinic 5 |
Clinic 6 |
|
|
Type of Practice |
Family Practice |
Family Practice |
OB/GYN |
OB/GYN |
OB/GYN |
Family Practice |
|
City |
Seattle |
Edmonds |
Bellingham |
Seattle |
Wenatchee |
Seattle |
|
# Chart Reviews |
105 |
50 |
51 |
50 |
0 |
50 |
|
# Provider Surveys |
15 |
3 |
2 |
8 |
6 |
1 |
|
# Non-pregnant surveys |
43 |
11 |
13 |
9 |
11 |
17 |
|
# Pregnant surveys |
13 |
8 |
43 |
29 |
16 |
11 |
Results to Date:
The inter-observer agreement
on chart reviews was >0.95. During pregnancy, the majority
(>80%) of patients remembered their physician discussing folic acid
supplementation, and over 80% of physicians recalled discussing folic acid
supplementation with their pregnant patients. Critically, about 70% of non-pregnant
patients did not recall a discussion about folic acid, and more than 80%
of physicians stated they did not discuss folic acid with their
non-pregnant patients. Documentation of patient education was
inconsistently recorded in charts, but generally supported the results of
the survey.
Conclusions to Date: For most of these women, education about folic acid supplementation occurred at an inappropriate time, i.e. after conception, when supplementation will not prevent neural tube defects. To rectify this situation, we initiated a multi-pronged statewide effort to improve folic acid educational practices: a state wide mailing, advising physicians of the importance of preconception folic acid supplementation; this website containing physician and patient information; articles in medical organizations’ newsletters; focus groups with medical practices to help develop useful educational materials; and development of a "Well Woman Visit" form to document educational efforts (see Chart Form link to the left).
Presentations to Date: We presented our results in two posters at the Inaugural Conference of the CDC's National Center on Birth Defects and Developmental Disabilities in Atlanta, GA on September 19th, 2002. Click here to see our poster presentations.
Note: Research conducted under the IRB title "March of Dimes Prenatal Health Survey".
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Last Update: December 2002 AJH
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