Will ECU take part in addressing maternal and infant health disparities in North Carolina?

Health

FILE: A pregnant woman holds her stomach. (Photo by Ian Waldie/Getty Images)

GREENVILLE, N.C. (WNCT) – Last year, East Carolina University expanded its services to help North Carolina women with high-risk pregnancies through an innovative program that combines telemedicine, telepsychiatry and nutrition support in order to improve health outcomes for babies and mothers.

The MOTHeRS Project at ECU stands for Maternal Outreach Through Telehealth for Rural Sites. The program eliminated the drive for Stephanie Massey of Newport who had to drive two hours in order to get the treatment she needed. Now, according to Healthier Moms, Healthier Babies “thanks to the MOTHeRS Project, Massey can now drive to her local Ob-Gyn 15 minutes away and receive specialist care through telemedicine visits.”

Dr. Sy Saeed, a psychiatrist from ECU, has been serving as the chairman of the Department of Psychiatry and Behavioral Medicine at the Brody School of Medicine since 2004. He also serves as the Director of the Center for Telepsychiatry at ECU and as the Founding Executive Director of the North Carolina Statewide Telepsychiatry Program (NC-STeP), a state-funded program covering over 60 hospitals and community-based sites across North Carolina. Psychiatry is an important element, especially with women who have high-risk pregnancies and are at risk for depression and postpartum depression.

Saeed’s work with the project began when he was approached with the issue of high-risk pregnant women missing their appointments with maternal-fetal specialists. He knew ECU was known for its work in telehealth and could help.

Therefore, he suggested that ECU could use a program similar to NC-STeP with a vision to assure that if an individual experiencing an acute behavioral health crisis enters an emergency department of a hospital anywhere in the state of North Carolina, she receives timely specialized psychiatric treatment through this program. Saeed wrote the proposal for the MOTHeRS Project and serves as an important component.

However, there lies another matter. On the MOTHeRS Project website, a statistic reads, “The United States continues to see a rise in maternal mortality rates with the highest rate of any other developed country. This rate is particularly higher for African American women, women living in rural areas and women with underlying conditions. Prior to COVID-19, North Carolina ranked 30th in maternal mortality and 41st in infant mortality.”

His focus is telehealth and telemedicine, and in a conversation, he went over the health disparities that are affecting women who have high-risk pregnancies.

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CLICK HERE Dr. Sy Atezaz Saeed’s report on using Telepsychiatry to enhance access to evidence-based care

Do you think this new innovative telehealth program will help reduce this problem for women of color living in rural parts of North Carolina just like Stephanie Massey?

“Well, of course! That was the whole idea of building a program that basically the purpose is to take care of people who otherwise may not have access to specialty care. So, because there are many things that get involved with that is why people cannot come to medical centers like ours here in Greenville. Our idea is to basically take care of them, so there are people who cannot come to their appointments in Greenville because of the distance, additional money it requires for gas, what have you. They may not have information about that and have fears of catching COVID, the disease. That was an idea that would bring care closer to their homes. According to compiled data, we were able to save money for people to travel, which obviously is not the most part of it, but here it’s supposed to reduce the health disparities by providing care closer to them, so distance is one part of that. The second part of that is, of course, the money because there’s many people in North Carolina who are either uninsured or underinsured. So, even though they have insurance, their physician or specialty care physician is not going to accept that or their uninsured and a specialty physician may not see that. By virtue of the fact, this is a grand funded program we make it available to all comers so whether they have insurance or not we provide care as good and best as any insurance they may have.”       

“Health disparities play a significant role in more than 50% of the women are provided treatment have other comorbid conditions as well as a problem with being morbidly obese or at least overweight.”

His study also defines the meanings of health equity, health inequities, and health disparities shown here:

Health equity is the absence of avoidable or remediable differences, allowing for the attainment of optimal health for all people. Health equity is achieved when everyone has the opportunity to attain their full health potential, and no one is disadvantaged because of socially determined circumstances. Achieving it requires focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.

Health inequities are unfair health differences closely linked to social, environmental or economic disadvantages that adversely affect specific groups of people. Inequity involves more than inequality with respect to health determinants and access to resources; it also represents a failure to avoid or overcome inequalities that infringe on fairness and human rights norms. It is important to understand that health inequities are different from health disparities.

Health disparities are measurable differences in health status between people that are related to social or demographic factors such as race, gender, income or geographic region. While ensuring equality in health and access to resources seems appropriate to mitigate health disparities, it should be noted that equality differs greatly from equity.

“Mental health is another part of the care with MOTHeRs Project because about as many as 13 percent of women who have just given birth or pre-natal or immediate post-partum will experience a mental disorder especially depression,” he said.

Racial disparities also are a factor. According to his research, Using Telepsychiatry to Enhance Access to Evidence-Based Care, “Nationally, more than 700 women a year die of complications related to pregnancy in the U.S., and two-thirds of these deaths are preventable. As of 2016, the U.S. pregnancy-related mortality ratio was 16.9 per 100,000 live births. However, there are significant racial disparities within this calculated statistic, as the following figure shows:”

Trends in pregnancy-related mortality ratios among race from 2007-2016.

Figure 4 gives examples of different mortality rates in North Carolina:

Saeed explained that “some of the things in which can impact these disparities is where you live, your income, and poverty level.”

  • How does health disparities tie into the infant mortality rate?

“Well, it ties in many ways. So, as you know, health disparity basically is a measurable difference in the healthy status between people that are related to social demographic factors such as, race, gender, income and geographic region. So, what it all relates to that is where you live, how much money do you make, car, are you insured, what’s the distance you travel to see your primary care, and/or do you get pre-natal care all these things tie into that. For a lot of people in Eastern North Carolina, the issue is the distance so think about like if you live in Ocracoke.

“So, what happened was one of the recent hurricanes was the only the healthcare facilities there and were both underwater and so how do you get that care? And so that becomes a part of that or do you have enough money to buy gas to drive a round trip or in some cases as much as six hours.”

Regarding the MOTHeRS Project, how will the program help target these racial disparities so that women of color who have a high-risk pregnancy can receive equal care?

“What we are doing is we are trying to take as many of the barriers to access to care out of the equation as we can. So, the reason they aren’t getting care is because of the distance. We are taking a specialist to their community through telehealth. If the barrier is that they don’t have enough insurance or they are uninsured we will see them regardless of their insurance or status. If the barrier is that there is no specialist available in their community and for most of the communities, it’s not so maternal-fetal specialist, it is very very few, and for Eastern Carolina basically, the medical center here in Greenville, ECU and Vidant is it.

“So, let’s say there’s someone living in Chowan County or Duplin County or Carteret County. None of those places have maternal-fetal specialists. So if a patient in that area said ‘well I don’t want to drive to Greenville because I can’t afford it’ or ‘I don’t have a car or transportation’ or ‘because I’m afraid that there’s COVID going on.’ We are taking all of those barriers out so that we see them in their community.

“The way we do that is we have built a relationship with local clinics so in three of these sites, there’s a local OB/GYN doc who sees these patients, and then what we do is we bring five other dimensions of care to them, we are telehealth.

So if the OB/GYN doc, let’s say in Duplin County, tells a patient that you have a high-risk pregnancy and would like to see a maternal-fetal specialist, in the past that could have taken a long time to make a referral and then for the patient to travel and come to Greenville. Now, what we do is we tell the patient ‘well the next time you are in the clinic or this afternoon, the specialist would like to see you on the screen, and then more than that if they are having the ultrasound being done, our maternal-fetal specialist can look at those images right there on the screen in real-time.

“Then, if they have depression, we would actually have this patient seen by a psychiatrist again on telehealth. If they have diabetes, we have diabetes educator involved with that, and one of the things which is really unique about this program is that many of the people in these communities are food insecure. So, in other words, they don’t have enough money, or they’ve run out of food before it’s time for them to buy the next batch when they get the money.

“All these patients are screened for food insecurity, and if they are determined to be food insecure, we have other specialists in the nutrition department. They have developed this medically tailored food bag so that has all the elements in it that people need as additional nutrients with pregnancy. We provide them as free of charge and we lend them to the resources near their community where they can actually continue to get enough food.

  • There is an ongoing initiative addressing maternal and infant health disparities in N.C., has or will ECU take part in joining this initiative?

“Well, so anything that has to do, anything with health and well-being for anyone in our region we are for it. So while you are speaking, I mean yes to answer that question would be yes. For any more specific on how that would be involved you will have to ask that department of OB/GYN.”

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