Prenatal and postnatal health care providers in Arkansas need to improve their approach to the public and collaborate more with each other, elected officials and health care professionals said Wednesday at a maternal health clinic at the University of Arkansas for Medical Sciences. Agreed at the health roundtable.
Sen. John Boozman's office is negotiating with Sen. John Boozman, Rep. French Hill, Gov. Sarah Huckabee Sanders (all Republicans), and four Arkansas doctors with experience in maternal and child care. coordinated the discussion. Jodianne Tritt, executive vice president of the Arkansas Hospital Association, moderated the panel.
“It’s so important to hear this kind of holistic story today…about how to be more efficient. [care] and consequences for our babies, mothers and families,” said Hill, who represents much of central Arkansas.
Arkansas is one of the three states Not taking advantage of the federal option to extend postpartum Medicaid coverage from 60 days to 12 months after birth. State Rep. Aaron Pilkington (R-Knoxville) introduced a bill to expand this coverage in 2023, but it stalled in Congress due to cost concerns.
“I'm not saying we need that additional level of legislation at this point, but I would like to see an effort to transition people past the first 60 days to other coverage options,” Sanders told reporters after the panel. We need to do better.” “…We want those moms to have one year of coverage. It already exists in the state, but we could do a better job moving forward educating them about what’s available.” you need to do.”
Everyone has great plans, but none of them are coordinated… We are running very low on resources and end up wasting a lot of resources.
– Alan Nichols, Mainline Health Systems CEO
According to the Arkansas Center for Health Improvement, Arkansas has the highest maternal mortality rate in the nation and the third highest infant mortality rate.
Part of 75 counties in Arkansas There is no hospitalMeanwhile, only 35 hospitals in the state have delivery departments. Since the onset of the Covid-19 pandemic in 2020, four units have been closed, said Dr. Nirvana Manning, chair of the Department of Obstetrics and Gynecology, the OB/Gyn practice at UAMS.Bradley County Medical Center in Warren recently closed its labor and delivery department. Due to staffing challenges.
Manning praised two state laws enacted in 2023. One would require Medicaid to cover postpartum depression testing, which physicians are currently required to provide to postpartum patients, and the other would require postpartum depression testing to be covered by postpartum patients, if they so choose. Requires Medicaid coverage of time-acting reversible contraceptive methods.
The Arkansas Legislature considered enacting broad maternal and reproductive health legislation in 2023
Manning said mothers should receive the best care possible, regardless of whether they plan to become pregnant again in the future.
“On top of taking care of a newborn child, getting through this postpartum period…the mother is the unit of it all, and when the mother falls apart, everything falls apart,” she said. “You need to evaluate how you can wrap [services] Around that mom, not only in that immediate period of 60 days postpartum, but in a long trajectory. ”
Dr. Sharmila Makhija, a gynecological oncologist, calls the postpartum period the “fourth trimester” of pregnancy and emphasizes the need for continued care, especially if the patient has pre-existing health problems. emphasized.
“Another way to approach this is to work with the pediatrician and have dual consultations at the same time, since the mother will be caring for the child all the time.” [would help] Because they always show up to make sure the baby can be seen,” said the founding dean and CEO of the Alice L. Walton School of Medicine, scheduled to open in Bentonville in 2025. Makhija said.
Alan Nichols, a member of the Arkansas Rural Health Partnership Board of Directors, explained to panelists and the audience why rural hospitals are struggling to keep labor and delivery rooms open. Nichols is CEO of Main Line Health Systems and will take over the labor and delivery department at Monticello's Drew Memorial Hospital in 2022. Baptist Health acquired this hospital in 2023.
Nichols said a fully staffed labor and delivery department contains a “critical mass” of four doctors each delivering 200 deliveries a year, and that a single hospital delivering 800 deliveries a year ” It can't be done everywhere,” he said.
“We need a hub-and-spoke program where everything is coordinated and everyone works together, with delivery areas across the state and a higher level of care,” Nichols said. “I don't know how many phones and videos [conferences] I've been there for the past year and a half and everyone has great plans, but none of them are coordinated. They're duplicating activities everywhere…We're in a state with very few resources, and we're going to waste a lot of resources. ”
“PR issues”
Dr. William “Sam” Greenfield said the medical community needs to move beyond routine doctor appointments during pregnancy and adopt a widely accepted definition of prenatal health care.
“Effective prenatal care is respectful,” said Greenfield, an OB/Gyn and member of the state's Maternal Mortality Review Board. “It's a risk assessment process to see where a patient falls on the spectrum in terms of what the risks are to pregnancy. It's treatment and intervention… it's about what to expect, what to look for. It’s an opportunity to educate them on what they should do and how to advocate for themselves.”
Dr. Ranita White, a UAMS faculty pharmacist, said mental and behavioral health services need to be included under the umbrella of prenatal and postnatal care. This is because the stigma associated with these issues contributes to maternal mortality.
“You'll be on a scale, it's part of the visit [to a doctor]“We talk about your blood pressure as part of the visit. We need to normalize these conversations and relish it so people get help when they need it,'' White said.
However, panelists said there are very few doctors in medical specialties, including pediatrics, in rural areas, and primary care physicians provide most of the medical care in these areas. Many Arkansas counties had few full-time primary care physicians per 10,000 residents in 2020. ACHI data.
2022, Arkansas Became the 48th state AIM creates a “patient safety bundle,” or maternal care plan and best practices, that state health systems distribute to health care providers. Manning said having information about emergencies that can occur during pregnancy and childbirth is an important tool for local maternal health providers.
Rural Arkansans face long ambulance wait times, national study says
Panelists agreed that Arkansas needs an efficient system to transport pregnancies and deliver patients from rural health care facilities to better equipped facilities on short notice. Manning said UAMS is working on such a mechanism in response to comments from Dr. Sherry Turner, rural director and associate dean of the Arkansas College of Osteopathic Medicine in Fort Smith.
“They come to me in that little er, I deliver [babies] “There's only one ambulance in the county, so it could take hours to get an ambulance,” Turner said. “…There’s a lot of work to be done outside of this structure.”
White said other barriers to care in rural areas include distance, transportation, for for for for for low income people, distance, transportation, and low income people. White is CEO of Community Health Centers of Arkansas, a nonprofit organization that provides health care regardless of a patient's ability to pay, a resource many Arkansans do not rely on. He said he did not know.
“When women don't have someone to pay for their health care, such as Medicaid or private insurance, they often believe that health care is out of their reach,” she says. . “…It's a PR issue for both sides.”
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