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Do you have formalized relationships with medical providers
and other health care programs in your state? Please describe.
Response from Georgia:
Our State Division of Public Health has a contract with the State chapter
of AAP. It allows us to have several liaisons (hired by them) to facilitate
communication and education between the two groups. Our liaison is a Nutritionist/RD/LD.
We have two advisory groups
that meet by telephone on a quarterly basis: the WIC Advisory Group
and the Breastfeeding Advisory Group. These have representatives from AAP,
OB-GYN and FP associations.
Response from Nevada:
We have very recently gotten an AAP representative for the state. At this point, the providers
are generally not receptive to information from anyone who is not a peer of theirs.
Response from Rhode Island:
Our state WIC breastfeeding coordinator (SBC) is integrally involved
with Physicians Committee for Breastfeeding and the Breastfeeding Coalition.
The SBC attends all group meetings, manages listserves for both groups,
acts as a community organizer and liaison between breastfeeding professionals
(IBCLC, VNAs, health insurers, MDs, midwives). This is a very effective
arrangement. SBC receives Title V funding to do this work.
Response from California:
We have a few medical providers who are on our Breastfeeding Advisory
Committee and meet with them regularly. They represent AAP, ACOG and Family
Practitioners. Otherwise, we have no formalized relationships at the Branch
level. Some local agencies have Memorandums of Understanding (MOUs) with
their respective Health Maintenance Organizations (HMOs). Some local agencies
are under medical entities that allow them to easily refer to primary
medical care, for example, WATTS Health Foundation.
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What specific efforts have you made to work with medical providers or
other health care programs? For instance, have you surveyed medical providers
regarding the WIC program?
If so, what was the outcome?
Response from Georgia:
Our liaison with the medical community conducted surveys to find out what the
main needs of the MDs were regarding health issues and WIC. We found out
there were some serious myths about the true purpose of WIC - such as, we
used WIC in public health to attract patients away from private providers.
We also found out they were hungry for information and resources on childhood
overweight, breastfeeding and feeding behaviors.
Each year, we will be focusing on four of our health districts
(we have 19), in order to help establish better communication,
to foster referrals back and forth, and to help provide WIC resources
in a way that MDs will make sure their patients utilize. The AAP
liaison does lunch and learns, mail-outs, education sessions (about
public health services, WIC and the three areas mentioned above).
She arranges for dialogue sessions between WIC/Public Health and
the MDs, when necessary.
The AAP liaison has created a web page dedicated to WIC and Nutrition
- on the State AAP site. She updates this as needed, with BF info,
infant formula updates, etc. She also includes articles in the
chapter newsletter and does mass mailings or faxes. One mailing
was used to show progress in the area of breastfeeding - as well
as to discuss the gaps in providing ongoing support for moms.
Response from Nevada:
There are two IBCLCs who work for WIC who see nearly all WIC newborns (d3 and
d10-14) at the newborn care clinic five mornings a week. They work directly
with two physicians who are very happy to have their help and support. We
would like to duplicate this program statewide.
Response from Rhode Island:
We have a provider liaison who visits medical offices with local WIC agency
staff to do a brief in-service on WIC and provide information and brochures.
This piece sometimes includes a breastfeeding component.
The State Breastfeeding Coordinator (SBC) is planning a meeting
with a large birthing hospital to develop a feedback mechanism
to provide hospitals with patient input on their birthing and breastfeeding
experiences. The SBC is currently working with health insurers
about getting information about breastfeeding benefits out to consumers
and providing information to providers about accessing these benefits.
Response from California:
Breastfeeding
We surveyed neonatologists
in our state to assess their knowledge and attitudes toward
breastfeeding and banked human milk for premature infants.
Exempt Formula
When developing the current screening and medical justification
forms for therapeutic formulas, we piloted the form with a small
group of MDs in order to see if the form was user friendly.
Contract Formula
An official letter was sent to medical providers regarding WIC’s
contract formula change.
Outreach
We have a medical provider packet that promotes breastfeeding and
offers nutrition education materials that medical providers can
freely order.
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Which aspects of your program elicit effective contact
with medical providers and other health care programs?
Response from Georgia:
Because most of our WIC programs are health department based, it is a bit simpler
establishing lines of communication.
Our Medicaid participants are given a medical home with private providers
(PH can only provide these services if there are no medical providers,
none willing to see all Medicaid, or the MD's agree to share provision
of health services or if the children are in foster care). So - if we detect
a medical problem we immediately initiate a referral to the MD (anemia,
low head circumference, medical emergency, whatever).
We also have increased the number of in-hospital (bedside) WIC certifications
we do. This allows for very close contact with medical providers.
We have provided our physicians with the Georgia contract infant formula
policy as well as our infant formula guide. This has kept most of the providers
aware of what we will or will not accept as a diagnosis or reason for switching
from contract to a non-contract formula, and which infant formulas will
not be issued. If we become aware of a physician or practice that disregards
the WIC policy, we work through our AAP liaison to provide appropriate
education to the physician. The chair of the GA AAP Nutrition Committee
(a gastroenterologist) will, at our request, provide education to physicians
who continuously recommend inappropriate formulas.
Response from Nevada:
When there is a discrepancy with information recommended by the provider, we
make sure to diplomatically provide peer reviewed information in an attempt
to educate without shutting down the lines of communication. Sometimes it
works and sometimes not, but it seems to be the least threatening method
at the moment.
Response from Rhode Island:
• WIC Provider Liaison
• Breastfeeding peer counselor program at local agencies
provides readily available
breastfeeding resource to health clinics.
• WIC updates and collaboration at Physicians
Committee for Breastfeeding and
Breastfeeding Coordinator
meetings.
Response from California:
Breastfeeding
Other programs in our agency have implemented activities to promote breastfeeding,
i.e. the Medi-Cal Managed Care Division sent a letter to all contracted health
plans clarifying their expectations for breastfeeding support. This was done
with input from WIC and as a result of the Medi-Cal Managed Care Division participating
on our Breastfeeding Advisory Committee.
Formula
By using WICs screening and medical justification form for exempt
formula, the medical provider saves time, because participant information
is gathered for their review.
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What communication methods have you used with medical providers and other health care programs?
For instance, do you conduct medical provider advisory meetings or send out letters or newsletters?
Response from Georgia:
I think I mentioned these above. We also had a breastfeeding telephone conference
training in September, and are in the process of developing another one in
child health. Our AAP liaison provides in-service training to medical practice
groups in the target areas for the year. Based on the needs of the practice,
the training might be a face-to-face training with the entire practice (from
physicians, to nurses, to front-office staff) or a mailing that includes
resources, WIC and other health department contract information, and referral
forms. In addition, updates and “hot’ information is sent through blast faxes
and letters to members, as well as posted on the chapter web page. Our liaison,
in collaboration with physicians who strongly support breastfeeding (including
one who is MD, IBCLC) have worked to have a breastfeeding room available
and a breastfeeding talk scheduled at each of the two annual chapter conferences.
We are in the process of finalizing a revised referral form. Previously,
the forms were provided to physicians for the purpose of soliciting
referrals to WIC. The new form is designed to be used for both referrals
from WIC to the medical community and from the medical community
to WIC.
Response from Nevada:
The new AAP representative will do some of that for us with her grand rounds
presentations etc. There is much provider resistance.
Response from Rhode Island:
• Site visits
• Blast faxes
• Direct mailings
• Public forums (grand rounds)
• Physicians Committee for Breastfeeding and Breastfeeding Coordinator meetings
Response from California:
We send emails to our Breastfeeding Advisory Committee Members who are physicians
and a few other interested physicians that we know about.
We send direct mailings to the Child Health and Disability Prevention
Program (CHDP) medical providers and write articles for HMO newsletters.
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Does your agency align with organizations, collaboratives or other sources that allow you access to medical providers
and other health care programs?
Response from Georgia:
Yes, this is one thing that this state is working on as a priority - regarding
not only WIC and Nutrition, but we have staff who help physicians with requirements
for EPSDT services (provide training of their staff, and monitoring of services).
We have close ties with immunizations as well since the State provides the
free and low cost immunizations for MDs to provide to our community.
Response from Nevada:
Same as above. We have task forces with physicians as members with whom I
am in contact.
Response from Rhode Island:
Same as #1.
Response from California:
When we distributed our neonatologist survey, we went through the neonatologist
on our Breastfeeding Advisory Committee.
When sending out information, we access medical providers through
the State Child Health and Disability Prevention Program (CHDP).
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Does your agency employ, contract or consult with medical providers and/or professionals from
other health care programs?
Response from Georgia:
Some of our local agencies operate in health departments in which medical groups
have been given space and/or contracts to provide medical services. This
eases the ability to cross-refer and to coordinate needed services.
Response from Nevada:
Only RDs, IBCLCs and cooperative extension at the moment.
Response from Rhode Island:
Not sure.
Response from California:
We have volunteer medical providers on our Breastfeeding Advisory Committee.
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As a result of your efforts with medical providers and other health care programs,
how have your program and participants benefited?
Response from Georgia:
We will be evaluating this, this year. Anecdotally, it has been wonderful.
I think the mutual respect that is developing will result in more referrals
and in consistency of the medical messages.
Response from Nevada:
Too early to tell as we haven’t been at this very long. Ask me in three to
five years.
Response from Rhode Island:
Incremental growth in breastfeeding awareness among providers and breastfeeding
infrastructure changes.
Response from California:
By informing medical providers about the recent formula contract change, WIC
saved time and money by avoiding prescriptions for non-contract formula.
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Was there any negative impact on your program? For instance, were
there increased costs related to WIC Program operations, such as, providing
training or training materials, accommodating increased referrals or requests
for special nutritional products, etc?
Response from Georgia:
It has all been positive.
Response from Nevada:
Not yet.
Response from Rhode Island:
Less time available for the State Breastfeeding Coordinator to focus on WIC
issues.
Response from California:
There has been no negative impact.
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What recommendations do you have for working with medical
providers and other health care programs in the current health care environment?
Response from Georgia:
First of all, it is critical. Our recommendations include:
• Get to know the medical community. Find out who they are,
where they practice, whom they
serve, their perception of WIC and Public Health,
what they would like out of the relationship.
• Find common ground – what will be of mutual benefit in the relationship
• Work with local agencies to get their staff talking with the medical providers
• Build staff competencies so that local agency nutritionists/dietitians
feel comfortable calling
a physician to discuss
a referral, breastfeeding information or a formula prescription.
• Sell the WIC staff competencies to the physicians so that
they see the value in working with
WIC staff and referring back to WIC.
• Invite physicians to participate as task force or coalition
members, even if they can only do
it in an advisory capacity.
• Keep the information flowing – rather than having a one-time
communication or
information campaign.
Response from Nevada:
You need to be very diplomatic and encourage dialogue without being overly
zealous.
Response from Rhode Island:
Help providers with their administrative burden. They don’t have time for
that aspect, but are often enthusiastic to work on the issues (in this case,
breastfeeding). Provide them only with information needed, process information
for them as needed, be very explicit about what you need from them, especially
effective in writing.
Response from California:
Our recommendation is that you find providers or health care programs that
are interested in your work (passionate about it) as they often work on their
own time to help out.
In the changing health care environment, WIC can assist the community
medical provider by providing assessment information, nutrition education,
breast feeding assistance and MNT referrals. This creates a working
partnership between WIC and health care providers where WIC is seen
as a positive resource instead of a public health program that makes
additional administrative demands.
