Doctors Miss Opportunity

Michigan physicians say their low-income patients would benefit from a state-run program to promote healthy pregnancies and births, but a new Michigan State University analysis shows few doctors refer women to the service.

Women enrolled in the Maternal Infant Health Program – which is offered at no cost to eligible mothers-to-be – receive home visits and a personal care plan. When needed, they also receive assistance with arranging transportation to prenatal care appointments, smoking cessation and referrals for substance abuse and domestic violence.

Low-income pregnant women typically face more barriers to medical care, said lead author Jennifer Raffo, a research project manager with MSU's Department of Obstetrics, Gynecology and Reproductive Biology in the College of Human Medicine. They have to take extra steps to enroll in health care and find a physician who will accept their insurance coverage, in addition to other life challenges.

While all Michigan women insured by Medicaid are eligible for the program, less than a third of them are enrolled. To learn more about why so few women participate, Raffo and colleagues surveyed OB-GYN physicians – who are a primary source of referrals to the service – at a large Michigan hospital system to gauge their familiarity with the program.

More than 90 percent of the 56 physicians who completed the survey said the program would benefit their patients, and that it would be appropriate to refer all eligible women. Yet, 60 percent said they did not refer their patients, more than a half didn't know if others in their office made referrals and a third didn't know what services were provided.

We need to find a better way to help them learn about these programs and incorporate the programs into their care, Raffo said. Physicians are inundated with pamphlets and brochures, so we need to do that education actively, not passively. They indicated time as a major barrier, so we need to consider what resources are needed to help physicians and program providers work together.

Such a low participation rate is a lost opportunity, Raffo said, because the program's comprehensive approach – which involves nurses, social workers and others – could help reduce rates of smoking during pregnancy, low birth weight and preterm birth as studies have shown with similar programs.

As soon as they enter prenatal care, eligible women should be enrolled in the program, she said. A challenge to provide all the services many of these patients need. It takes a whole medical neighborhood to do that.

The study was part of a long-term research collaboration between the university and the Michigan Department of Community Health led by Lee Anne Roman and Cristian Meghea, faculty members in the College of Human Medicine. It appears in the Journal of Public Health Management and Practice.

More Information can be found on the MSU Today Website