Last summer, around the same time Mississippi declared a state of emergency over the country’s highest infant mortality rate, Amy Catherine Love Baggett, PharmD, deployed a team of pharmacists and community health workers to identify pregnant women and provide them with education and care.
“We thought, ‘How do we meet these women where they are? Can we catch them early, and can we help them through their entire journey in their pregnancy to healthy mom and healthy baby?’” said Love Baggett, co-owner and vice president of Love’s Pharmacy and network facilitator of Community Pharmacy Enhanced Services Network (CPESN) Mississippi.
The Medications Optimizing Maternal Safety (MOMS) program involves both pharmacists and pharmacy technicians who are cross-trained as community health workers. The program was developed by CPESN Mississippi in partnership with CPESN Community Health and the Community Pharmacy Foundation.
Pharmacy-based community health workers conduct outreach at local women’s resource centers, high schools, and family health centers to spread the word about the program. They also help women enroll in Medicaid and access local services, and they follow-up throughout the program to help address barriers to care.
Pharmacists, meanwhile, provide prenatal vitamins and check in monthly throughout pregnancy and after birth. The check-ins can be virtual, but at least one screening per trimester must be in person.They monitor blood pressure, screen patients for depression using a validated questionnaire, update vaccinations, and provide low-dose aspirin to prevent preeclampsia when indicated.
So far, 76 pregnant women have enrolled in MOMS, which has been offered at three pharmacies in southern Mississippi co-owned by Love Baggett. The program is now expanding to 14 community pharmacies across the state.
Christen Haygood, MD, an ob/gyn in Jackson, Mississippi, who has helped integrate the MOMS program with obstetrician-led prenatal care, said ob/gyns who have followed patients enrolled in MOMS “are appreciative to have the additional assistance.”
Women in Mississippi face many more barriers to getting prenatal healthcare than women in most other states. More than half of Mississippi counties are maternity care deserts, according to a March of Dimes 2024 report, compared with roughly one third of counties nationally. Mississippi has one of the highest rates of infant and maternal mortality in the country. In 2024, its infant mortality rate reached 9.7 deaths per 1000 live births, compared to the national rate of 5.6 deaths per 1000 live births.
One major barrier, said Haygood, is that there aren’t enough prenatal care providers. Women often wait 6-8 weeks to get an appointment. “There are a lot of patients who are high risk or don’t even know they’re high risk,” Haygood said.
Socioeconomic barriers can make delays longer. “Sometimes patients are waiting on Medicaid approval or they’re waiting for someone who can give them a ride,” Haygood explained.
Love Baggett said the program is not designed to replace care from a pregnancy care provider, but to augment it, often by connecting patients to obstetricians or family physicians earlier. “Moms have come to me at 15 weeks pregnant, who ideally should have been to their provider at least once at this point, and they have no provider,” she said. “We’ve actually set them up with their first appointment with those providers.”
Community health workers are key to the program’s success, Love Baggett added. They might connect patients with a Mississippi Department of Health program that provides transportation funds, coordinate housing or food bank access, or help women get supplies and equipment such as a car seat, and a crib. “Addressing maternal health deserts is about healthcare, but it’s also about nonmedical drivers of health,” she said.
Early findings published by Love Baggett and colleagues in Pharmacy Times are promising. The report found that 17% of patients were started on aspirin by the pharmacy team, 7% were referred to a healthcare provider for depression, and 20% were referred for hypertension. Women were identified early, with 84% of first encounters with MOMS occurring within the first 16 weeks of pregnancy.
The evaluation also showed the program is reaching patients with substantial needs. Only 23% of patients had commercial insurance; 43% had Medicaid, and 23% were uninsured. More than 65% of patients had at least one health-related social need, such as transportation challenges, lack of access to a routine healthcare provider, or inadequate housing.
Beyond the data, Love Baggett said patients have been grateful for the extra support. One patient who enrolled in the program had a history of multiple miscarriages. She qualified for aspirin for preeclampsia prevention and had never been put on aspirin in any of her prior pregnancies, said Love Baggett. Through MOMS, the pharmacy team started aspirin, connected her to a local provider, and later provided education and medication after she was diagnosed with gestational diabetes. The patient delivered a healthy baby this past spring. “I’m really excited about that,” said Love Baggett.
Lindsey Rayborn, PharmD, clinical assistant professor of pharmacy practice at The University of Mississippi in Oxford, Mississippi, and a CPESN Mississippi network facilitator, said the next phase of evaluation will assess the expanded program’s impact on infant and maternal health outcomes.
Rayborn, who has been involved with the initial implementation, expansion, and evaluation of the program, said CPESN Mississippi is also working to identify best practices and challenges with implementation, which will inform a toolkit for pharmacies. “Now that we have proof of concept, we’re shifting into workforce scalability,” she said.
Because pharmacies are far more plentiful than family practice clinics and hospitals, they are easier to access. One US study found that patients see pharmacists 1.7 times more often than they see physicians.
“We have the benefit of seeing patients more than any healthcare provider on the healthcare team,” said Love Baggett. “The more that you talk to somebody, the more that they start to trust you…they start to open up to say, ‘Hey, I’m having food insecurity,’ or ‘Hey, you know, our lights are going to be cutoff.’”
The pharmacy can also identify when care needs to be escalated. Love Baggett said that if a patient’s blood pressure rises, a depression screen is positive, or the pharmacy team identifies any other concerning signs or symptoms, team members call the prenatal provider and push for an earlier appointment.
Healthcare providers and officials from several other states have reached out to Love Baggett and Rayborn for advice on implementing pharmacy maternal health services based on the MOMS model, Rayborn said.
Nebraska is one of them. Staci Hubert, PharmD, managing network facilitator for CPESN Nebraska, helped incorporate a maternal health component into a rural health transformation proposal with the Nebraska Department of Health and Human Services.
Nebraska’s program has just begun with 15 pharmacies in the state’s rural western counties. The pharmacy checklist includes blood pressure, hemoglobin and A1c levels, mental health screening, vaccination screening, tobacco and drug use screening, HIV and sexually transmitted infection screening, assessment of social determinants of health, education, and referral to a primary care provider.
“A lot of times, patients say, ‘Hey, I’m pregnant. Is it safe for me to take this medication? We might be the first ones to hear about it,” she said. “I just think pharmacy prenatal care makes sense.”
Love Baggett, Rayborn, and Haygood reported being affiliated with the MOMS program, a partnership between CPESN Mississippi, CPESN Community Health, and the Community Pharmacy Foundation. Love Baggett co-owns three pharmacies that have implemented the MOMS program. Hubert reported serving as the Managing Network Facilitator for CPESN Nebraska. They reported having no relevant financial disclosures.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.