Indiana University Health Ready to Meet Community Needs

Like all medical facilities around the country, Indiana University Health (IU Health) is responding to coronavirus (COVID-19). In the midst of this pandemic, patients are relying on PAs and other healthcare providers more than ever to diagnose, treat, and care for their symptoms.

Since COVID-19 spreads so easily, telemedicine is quickly becoming an ideal way for patients and providers to communicate. Lindsey Kocher, PA-C, has experience in both primary care and emergency medicine and recently joined IU Health’s Virtual Care Division. She talked to AAPA about how IU Health is dealing with the COVID-19 pandemic, and how telemedicine is integral to the future of healthcare.

AAPA: Tell us about your role at IU Health.

Lindsey Kocher (LK): I worked for IU Health initially through the IU Health Bloomington Hospital emergency room in 2008. For the last four years I have worked in primary care and very recently accepted a position in the Virtual Care Division to head up a program focused on targeting our Accountable Care Organization patients who struggle to be seen in an outpatient setting due to physical and/or social barriers.

Can you tell us about the IU Health Virtual Visit app?

LK: The IU Health Virtual Visit app has been used as an on-demand service for patients seeking evaluation for various symptoms and concerns. We decided as the coronavirus was emerging in the U.S. that we could also utilize this service to offer patients free virtual coronavirus screenings that could be conducted in the safety and comfort of their own homes.

[Rush University PAs Integral to Coronavirus Response]

How does telemedicine specifically show promise for treating infectious disease/COVID-19?

LK: First and foremost, I believe we have the ability to improve containment efforts since we are able to properly educate patients on when and how to care for themselves and their family. We have been able to identify at-risk individuals and facilitate their safe transport to a health facility with proper infection prevention protocols already in place. Regarding infectious disease, telehealth can certainly expand our antibiotic stewardship by preventing or limiting unnecessary exposure of many viral illnesses in outpatient settings where there is a much higher risk of serious infection transmission among our most fragile patients.

Read the full article here.

MedPage Today

Study details aspirin nonadherence impacts on obstetric complications

Greater aspirin adherence was associated with better preeclampsia prevention in high-risk pregnancies, according to an observational cohort study.

Inadequate adherence, seen in 63 of 145 women prescribed prophylactic aspirin in the study from Australia, was linked to a higher incidence of:

Early-onset preeclampsia (17% vs 2% with adequate adherence, OR 1.9, 95% CI 1.1-8.7)

Late-onset preeclampsia (41% vs 5%, OR 4.2, 95% CI 1.4-19.8)

Intrauterine growth restriction (29% vs 5%, OR 5.8, 95% CI 1.2-8.3)

Preterm delivery (27% vs 10%, OR 5.2, 95% CI 1.5-8.7)

Increase in antihypertensive use antenatally (60% vs 10%, OR 4.6, 95% CI 1.2-10.5)

Good aspirin compliance was linked to lower odds of premature delivery -- the only treatment for preeclampsia -- on Kaplan-Meier analysis (HR 0.3, 95% CI 0.2-0.5), a study team led by Renuka Shanmugalingam, MBBS, of Liverpool Hospital in Australia, reported online in the Hypertension journal.

With an absolute risk reduction of 51% and number needed to treat of just two when adherence is ≥90%, the authors concluded that aspirin is "an effective prophylactic agent" for the prevention of preeclampsia.

"Therefore, suggesting adequate adherence with aspirin is essential and that nonadherence with aspirin among high-risk pregnant women may result in preventable obstetric complications," they urged.

They acknowledged, however, that aspirin for preeclampsia prophylaxis "remains controversial" because of conflicting data.

Read more.

ACOG Today's Headline / Chicago Tribune

Less than 5% of pregnant women have good heart health, according to Northwestern study. Experts say doctors need to do more in response.

Cardiovascular disease is the leading cause of death during pregnancy and the postpartum period, and U.S. health experts are working to better understand why so many moms are dying.

But many women might be unaware of their heart risks while pregnant — and the importance of taking steps to improve heart health is becoming more clear in light of a new study.

On Monday, Northwestern Medicine researchers published what they say is the first study to examine the cardiovascular health of pregnant women in the United States.

Using 15 years of data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, the Journal of the American Heart Association article analyzed records of 1,117 pregnant and 8,200 nonpregnant women, assessing key factors including diet, exercise and blood pressure.

Read more.

Medium / Surabhi Verma

"My name is Kristy Goodman and I’m the Co-founder & CEO of PreConception, the first and only direct-to-consumer preconception testing platform for women planning a pregnancy. My background is in medicine and I worked as a women’s health PA for several years before starting PreConception. Working in Ob/Gyn I realized how few women were receiving appropriate preconception testing and education before pregnancy and decided to leave clinical practice to start PreConception and bring preconception testing to women across the country through an online platform."

Read the full article here!

ACOG Today's Headlines / MedPage Today

MedPage Today (2/7, D'Ambrosio) reported research based on CDC data from 2003 to 2016 revealed a decrease in maternal deaths in medical facilities. However, over the same period, “the rate of pregnancy-related deaths in the home nearly doubled.” Moreover, “increases in pregnancy-related death rates during this period were most dramatic in women age 45 and older,” according to a presentation at the Society for Maternal-Fetal Medicine annual meeting.

Read more.

ACOG Today's Headline / CBS NEWS

CBS News (2/7) reported “heart disease is known to kill nearly 420,000 women in the U.S. each year, and is the leading cause of maternal deaths.” Moreover, “We’re seeing that there’s actually an increase in the number of heart attacks during pregnancy, and that number is going up in the United States,” one cardiologist told CBS news. In addition, research published in the National Vital Statistics Report “found that about one in four pregnancy or postpartum deaths are caused by cardiovascular complications – hypertensive disorders in particular affect as many as one in 10 women and cause increased risk of heart failure, heart attack, and stroke.” 

Read more.

Journal of the American Academy of Physician Assistants: December 2019 - Volume 32 - Issue 12 - p 11–12

Gajarawala, Shilpa N. DMSc, MPAS, PA-C; Wood, Tiffany A. BSHS; Stanton, Amanda P. MHS, PA-C

ABSTRACT In small clinical trials, dehydroepiandrosterone (DHEA) has been found to relieve symptoms associated with postmenopausal conditions and infertility in women. DHEA may provide a cost-effective alternative to typical hormone therapies. Because of a lack of long-term and large-scale studies, only intravaginal DHEA supplementation is approved and recommended for treatment. Further investigation of DHEA supplementation is needed and encouraged to determine its safety and effectiveness.

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Washington, D.C. – Ted L. Anderson, MD, PhD, president of the American College of Obstetricians and Gynecologists (ACOG), issued the following statement regarding the vote out of the House Energy and Commerce Committee on H.R. 4995 and H.R. 4996: 

“ACOG applauds the House Energy and Commerce Committee for advancing H.R. 4995 and H.R. 4996. The committee took a giant step toward eliminating preventable maternal deaths with these two critically important bills that will improve maternal health outcomes and build upon legislation passed last year.

“These bills include ACOG’s top legislative priorities in the “Momnibus,” a collection of U.S. House and Senate bills aimed at addressing the maternal mortality crisis. Specifically, H.R. 4995 and H.R. 4996 will 

• help hospitals and maternity care providers implement clinically proven best practices,
• incentivize states to continue Medicaid or CHIP coverage for women for one year after delivery,
• increase access to maternity care in rural and underserved areas,
• work to eliminate racial and ethnic disparities in maternal health, and
• provide support for perinatal quality collaboratives.

“Typically, women lose Medicaid coverage 60 days after delivery. This legislation would help ensure that moms receive care beyond that period for serious health conditions, including cardiovascular disease, postpartum depression, and opioid use, and close a huge gap in women’s health coverage during a time in which the Centers for Disease Control and Prevention show one-third of preventable maternal deaths occur.

"ACOG is very appreciative of House Energy and Commerce Chairman Frank Pallone and Ranking Member Greg Walden; Health Subcommittee Chairwoman Anna Eshoo and Ranking Member Michael Burgess, MD, FACOG; and Representatives Robin Kelly, Larry Bucshon, MD, Eliot Engel, and many more. It’s notable that the committee members are working across the aisle to deliver solutions to the nation’s maternal mortality crisis. We applaud their work and look forward to collaborating with all members of Congress to bring these bills to the floor of the House and Senate.”

To learn more about recent state action to extend Medicaid coverage to pregnant women for a year after delivery, view ACOG’s map.

APAOG Member Benefits

With over 250 members, the Association for Physician Assistants in Obstetrics and Gynecology is the only professional association devoted exclusively to PAs practicing in women's health. Established in 1991, APAOG is the collective voice for professionals working to improve the health care of women.

APAOG commitment to its members:

• To advocate for patient autonomy through education and collaborative care.
• To promote clinical and academic excellence for members of APAOG.
• To provide members with a forum to discuss topics that relate to PA's practicing in women's health.
• To assist and support PA's and the healthcare team by providing information through education and programs relating to the delivery of quality women's healthcare services.

Benefits of Membership 

• Free on-demand webinars and archived webinars, & training opportunities
• Join the APAOG Board, or serve on a Committee
• Monthly e-Newsletter
• Networking opportunities
• Access to members-only online resources
• Free job postings in Career Center
  

Download an APAOG Membership Flyer Here

JOIN or Renew Today!

October 6-12, AAPA

Every year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health.

This week is also an opportunity to raise awareness and visibility of the profession. Before it was a week-long event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6 is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD.

More information here!

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