Resident Knowledge And Residency Program Practices Regarding Pregnancy Testing And Prenatal Care Referrals Within The Kalamazoo, Mi Medical Community
BACKGROUND: Kalamazoo County (KC) has a significantly higher rate of infant mortality than the state of Michigan as a whole, with large disparities between black and white infants.
While causation is multifactorial, a contributing factor is lack of access to first trimester prenatal care. In 2015, only 64.3% of pregnant women in KC received first trimester care compared to 73.4% in the entire state. The first step for improvement is to assess the referral process for women who receive a positive pregnancy test at local emergency departments and outpatient clinics.
METHODS: REDCap surveys were emailed to WMed residents in emergency medicine (EM), internal medicine (IM), medicine-pediatrics (MP), pediatrics (P), and family medicine (FM) to assess knowledge of institutional protocol for pregnancy testing and prenatal care referrals. We also conducted semi-structured interviews with department leaders to determine their current protocols.
RESULTS: 60 survey responses were collected: 20 EM (33% response rate), 12 FM from FHC (50% response), and 28 combined Oakland drive primary care: IM, MP, P (38% response). Overall results showed a near 50-50 split on residents being aware of a protocol or not (Q1). Responses to questions 2 and 3 showed uncertainty involving patient education and referral protocols.
CONCLUSIONS: There is uncertainty regarding the existence of protocols for when to order a pregnancy test as well as what processes to implement upon receiving positive test results. Review of institutional protocols, and educating residents regarding this, should be undertaken to help improve prenatal care rates in KC.