The GAFP helps its members achieve NCQA recognition as a Patient-Centered Medical Home (PCMH).

Public Health Resources

GAFP is seeking a Family Physician Who is Exemplary in Supporting Georgia’s Maternal and Health Population

The Georgia Academy, in collaboration with the Department of Public Health, is seeking nominees for members who have supported Georgia’s mothers and children above and beyond the scope of family medicine.  Last year’s awardee was Dr. Andrea Videlsky of Marietta who has co-founded the Adult Disability Medical Home Clinic.  The clinic provides resources to adults with down syndrome and their families.

We are looking for YOU or a colleague to let us know about what you are doing in your community.  Please email Tenesha Wallace (twallace@gafp.org) with the name of your nominee and a few sentences about what makes them unique in their support of healthy moms and children.  The award will be presented at our Summer CME meeting in June.  Please send us a response no later than April 20th.

 

“Hey Baby, Can You Hear Me Now?”

Georgia’s Early Hearing Detection and Intervention (EHDI) Program is a system of care for early identification and intervention of children with congenital hearing impairment. The EHDI Program’s benchmarks are to screen by one month, to diagnose by three months, and to enroll into intervention by 6 months, also known as a 1-3-6 goal.  Children identified as deaf or hard of hearing (D/HH) move through a multi-partner system that begins with initial hospital screening and includes two public and multiple private intervention providers in Georgia. Although navigating intervention resources can be challenging for many families with hearing impaired children, studies show intervention beginning as early as six months of age that includes access to communication can positively impact that child’s speech and language development and consequently their ability to learn.

Georgia’s EHDI program is currently monitoring language development of children identified at birth with hearing loss through the 100 Babies Project.  The purpose of the project is to identify and explore factors that influence language development of D/HH children identified through newborn screening, including maternal and social factors, age of intervention, intensity of intervention and home language.  We suspect that not all children in Georgia are meeting language milestones despite being enrolled in early intervention due to maternal and social factors. Although research supports early intervention by six months of age to attain improved development outcomes for deaf and hard of hearing children, vulnerable populations of children may be at greater risk for not meeting language outcomes despite early intervention.  Results from the evaluation are being used to develop and implement strategies so that newborns and infants identified as D/HH do not fall behind their hearing peers.

Currently, the results of this evaluation further support that early identification by three months and early intervention by 6 months for D/HH children have improved outcomes compared to their peers.  The EHDI program is striving to remove barriers to timely identification, reduce referral time into intervention, and promote the importance of intervention for all D/HH children.  As a provider of essential care for children with hearing loss, it is crucial that you ensure families understand the importance of following up on the newborn hearing screen and enrollment of intervention after a possible diagnosis of permanent hearing loss with Georgia’s Part C Program (Babies Can’t Wait).

If you have any questions about newborn hearing screening or 100 Babies, please contact Kelly Dundon, AuD MPH at Kelly.dundon@dph.ga.gov or 470-283-9259.

 

Is She or Isn’t She – Preterm Labor Assessment Toolkit
Anne Lang Dunlop, MD, MPH, FAAFP

While few family physicians are continuing to deliver babies after residency training, most family physicians still provide prenatal care and many care for pregnant women through their first and second trimesters.

It is not a surprise that recent studies support that babies born full term (39-40 weeks gestational age) experience better outcomes than infants born even a few weeks early and than infants born preterm (< 37 weeks gestational age).  The Georgia Academy joins the March of Dimes as a leader in maternal and child health committed to improving perinatal outcomes and reducing preterm deliveries. One strategy for reducing preterm deliveries is the appropriate assessment and management of preterm labor.

According to substantial evidence in the literature, there continues to be wide variation in the practices used to assess pregnant women presenting with symptoms of preterm labor. Together with the co-authors, the March of Dimes has spearheaded the development of a Preterm Labor Assessment Toolkit to help clinicians establish a standardized clinical pathway for the assessment and disposition of women with suspected preterm labor. Better identification of women in preterm labor will not only provide timely and appropriate interventions; it will also promote effective management to improve neonatal outcomes.

We ask that you review this revised evidence-based resource that can be implemented at all levels of maternity care. This edition incorporates advances in research and best practices and outlines a step-by-step guide to standardized assessment. The toolkit is not intended to dictate practice. Instead, we urge you to examine how patients in suspected preterm labor are currently being assessed and triaged to understand how this toolkit can support practice improvement.

The March of Dimes Preterm Labor Assessment Toolkit is divided into the following sections to help streamline access to the information most relevant to each type of user (such as health systems and clinics, providers, patient educators).

  • Overview; preterm labor assessment and clinical disposition of patients.
  • Algorithm, Protocol and Order Set
  • Recommendation for Data Collection
  • Implementation Guidelines
  • Patient Education and Home Care Instructions
  • Appendices – including case studies, areas of evolving care, implementation PowerPoint presentation

A free copy of the toolkit can be downloaded at prematurityprevention.org. Registration is required. Additionally, in support of this initiative, the Georgia Department of Public Health is willing to provide technical assistance, training and PLAT materials to all interested birthing hospitals, particularly Level I and Level II facilities, free of cost. Please feel free to contact Terry Ann Harriott at Terryann.Harriott@dph.ga.gov for more information. We hope this proves to be a useful educational resource.

Preventing Congenital Syphilis in Georgia
Michelle Cooke, MD, Board Certified Family Physician

In 2007, The World Health Organization launched a global initiative to eliminate congenital syphilis.[1] In 2015, the State of Georgia stood in solidarity with this mission with the passing of HB 436 in the Georgia legislature. This law mandates testing for HIV and syphilis for pregnant women in the first and third trimester. Previous prenatal guidelines called fortesting of HIV and syphilis in the first trimester only. While the first trimester testing strategy helps identify opportunities to treat and prevent congenital syphilis, this strategy can miss cases of syphilis acquired later in pregnancy and put newborns at unnecessary risk.

The Georgia Law specifies that “every physician and health care provider who provides prenatal care of a pregnant woman during the third trimester of gestation shall offer to test such pregnant woman for HIV and syphilis at the time of first examination during that trimester or as soon as possible thereafter, regardless of whether such testing was performed during the first two trimesters of her pregnancy.” The bill goes on to specify that “If at the time of delivery there is no written evidence that an HIV test or a syphilis test has been performed, the physician or other health care provider in attendance at the delivery shall order that test for HIV, syphilis, or both be administered at the time of the delivery.”[2]All Congenital Syphilis cases must be reported within 24 hours to your local District health office or entered into Send SS. This includes babies without congenital syphilis symptoms, but who were born to mothers with untreated syphilis at time of delivery.[3]

Newborns acquire congenital syphilis through transmission of spirochetes through the placenta. Less commonly, syphilis can be acquired through direct contact with an infected lesion shortly after birth. Syphilis is not transferred through breast milk, however, syphilis may be transferred during breast feeding if the mother has an infectious lesion such as a chancre on her breast. Breastfeeding can be safely resumed provided that the breast is clear of lesions. Syphilis is more likely to be transferred vertically from a mother with untreated primary or secondary syphilis or with mothers co-infected with HIV.[4]

Syphilis can be screened in pregnancy with a nontreponemalantibody test such as the RPR or VDRL. In cases where syphilis is identified, treatment must be offered.  Penicillin G is the only known effective treatment for preventing maternal transmission to the fetus and treating fetal infection. Women with a penicillin allergy should be desensitized prior to treatment and given penicillin as there are no known effective alternatives. Be aware that treatment for syphilis can induce the much feared Jarisch-Herxheimer reaction, where endotoxin released from spirochetes during antibiotic therapy can cause a systemic inflammatory response. In pregnancy, this reaction can cause preterm contractions and other pregnancy complications. Thus, women treated for syphilis, especially after the second trimester should be educated about the signs of this reaction. The sexual partners of infected women should be identified and evaluated for treatment. Most protocols recommend that partners be treated presumptively for early syphilis, even if serologic testing is negative.[5] Partner treatment can help preventre-infection of mothers previously treated for syphilis.

In cases where syphilis has identified in a pregnant mother, early detection of congenital syphilis is essential. Such mothers should be offered sonographic evaluation during time of pregnancy, with special attention given towards evaluating signs of congenital syphilis.[6] After birth, neonatal providers must have a high index of suspicion for congenital syphilis, as up to 90% of early congenital syphilis cases are asymptomatic. Some early findings may include hepatomegaly (enlarged liver), jaundice, nasal discharge, rash, and skeletal abnormalities. The pathognomonic findings of congenital syphilis such as facial deformities (frontal bossing), Hutchinson’s Teeth, and sensorineural hearing loss are rarely present at birth. Therefore, the absence of these findings does exclude congenital syphilis.[7] Treatment of congenital syphilis is a10-day course of intravenous or intramuscular penicillin.[8]

In 2015, there were 21 reported congenital syphilis cases in the state of Georgia, all of which were completely preventable. Per CDC’s 2015 STDSurveillance Report, Georgia ranked 8th (among the 31states that reported any congenital syphilis cases), with a rate of16.3 cases per 100,000 live births (compared to the U.S. rate of 12.4). We have the tools and resources to ensure that no other Georgia newborn is born with the burden of syphilis. Prevention with early detection and early treatment works. We know that treatment at least 30 days prior to birth is effective at decreasing the odds that a baby is born with congenital syphilis. Please test for syphilis and HIV in the first AND third trimesters of pregnancy and join us in reducing the number of congenital cases of syphilis in our state.

If you have any questions or concerns, please contact your local district health office or call the Georgia Department of Public Health at1-866-PUB-HLTH (1-866-782-4584).

[1] The World Health Organization. The global elimination of congenital syphilis: Rationale and strategy foraction.http://www.who.int/reproductivehealth/publications/rtis/9789241595858/en/

[2] Georgia HB 436 – Georgia HIV/Syphilis Pregnancy Screening Act of 2015

[3]Georgia Department of Public Health.  https://dph.georgia.gov/

[4] Up to Date. Congenital Syphilis: Clinical Features and Diagnosis. https://www.uptodate.com/contents/congenital-syphilis-clinical-features-and-diagnosis?source=search_result&search=congenital%20syphilis&selectedTitle=1~57#H110903715(Accessed January 11, 2017)

[5] CDC. 2015 Sexually Transmitted Disease Treatment Guidelines. Syphilis During Pregnancy, https://www.cdc.gov/std/tg2015/syphilis-pregnancy.htm(Accessed January 11, 2017)

[6] CDC. 2015 Sexually Transmitted Disease Treatment Guidelines. Syphilis During Pregnancy, https://www.cdc.gov/std/tg2015/syphilis-pregnancy.htm(Accessed January 11, 2017)

[7] Up to Date. Congenital Syphilis: Clinical Features and Diagnosis. https://www.uptodate.com/contents/congenital-syphilis-clinical-features-and-diagnosis?source=search_result&search=congenital%20syphilis&selectedTitle=1~57(Accesses January 11, 2017)

[8] CDC. Congenital Syphilis. https://www.cdc.gov/std/tg2015/congenital.htm(Accesses January 11, 2017)

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TO: Healthcare Submitters and Providers

FROM: The Georgia Department of Public Health, Newborn Screening Program

RE: Newborn Screening Tests and Laboratory Analysis Fee Increase for FY 2017


Summary: During the 2016 legislative session HB751, Item 3052, to provide funds for therapies for children with congenital disorders was passed.  On April 7, 2016, the Department of Public Health published a Notice of Proposed Rule Making to amend Department of Public Health Regulation 511-5-5-04, pursuant to O.C.G.A. § 31-2A-6 and § 31-12-6(f).  As outlined in a memo sent out on July 1, 2016, The Georgia Department of Public Health, Newborn Screening Program proposed a fee increase from $50.00 to $63.00 to cover the Department’s actual cost associated with newborn screening.  This fee increase will enable the Department to screen for Severe Combined Immunodeficiency, a new critical condition added to the newborn screening panel, as well as provide therapies for children with congenital disorders.

Steps to Final Adoption: The fee increase has been approved by DPH as outlined in a memo sent out on July 1, 2016.  At their September 8, 2016, meeting the Department of Community Health (DCH) board voted for final adoption of a rate increase to reimburse Medicaid providers for the new fee amount. The next step in the approval process is for the Centers for Medicare and Medicaid Services (CMS) to provide approval.  Upon final approval from CMS and DCH, the fee increase will be universally adopted for newborn screening specimen collection in the state of Georgia. We will send a letter of notification, which will also include an effective date.

If you have additional questions, feel free to contact Judith Kerr, Interim Child Health Screening Program Manager at (404) 657-2878 or judith.kerr@dph.ga.gov.

 

Zika Letter from DPH

Zika Webinar from Georgia DPH

 

CDC Zika Resources

Zika Guidelines from DPH, a February 23, 2016 Webinar on Zika from DPH, and CDC Zika resources.
Contraception and HPV Vaccination Resources

Title X Clinics

DPH Clinics

Planning for Healthy Babies Medicaid Waiver

GPower App

Teen Friendly Care Infographic

Nexplanon Training

Online LARC Training

Various available resources including clinics in Georgia that can provide contraception to teens, information for providers working with teens, and LARC trainings.
Adult Immunizations Schedule Lists the specific immunizations adults need as determined by factors such as age, lifestyle, high-risk conditions, type and locations of travel, and previous immunizations.
Dental Site Map An interactive map showing Georgia’s dental public health sites by the Georgia Oral Health Coalition.
Centers for Disease Control and Prevention Disease Atlas An interactive tool for accessing HIV, AIDS, viral hepatitis, tuberculosis, chlamydia, gonorrhea, and primary and secondary syphilis data collected by the Centers for Disease Control and Prevention’s (CDC’s) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).
Children First – Public Health Program for Children Birth to Five

District Coordinators

Screening and Referral Form

Children First is a program of the Georgia Department of Public Health that identifies children who are at risk for poor health and developmental outcomes so that needed interventions can be made to ensure the optimal health and development of the child. Participation is voluntary and there are no financial requirements for enrollment into the program.
Children’s Medical Services (CMS) CMS works to provide improved health outcomes for children with special health care needs by coordinating their access to affordable quality specialty health care in our communities and by using the resources in a responsible manner.
DPH Youth with Special Health Care Needs  This guide is loaded with valuable information and contains a portable medical summary which the physician providing pediatric care of the adolescent will complete for the adult care physician.
Georgia SHAPE Under the leadership of Georgia Governor Nathan Deal, Georgia SHAPE is a network of partners, agencies and athletic teams committed to improving the health of Georgia’s young people by offering assistance and opportunity to achieve a greater level of overall fitness.
Georgia Department of Public Health (GDPH) 

District Health Directors

News

Resource Index

Resource Finder

Leadership list with links to Georgia’s 18 Health Districts and 159 county health departments.Up-to-date news and announcements.Access information on GDPH programs organized by divisions:  District

  • District and County Operations
  • Health Promotion
  • Health Protection
  • Vital Records

An A-Z finder of GDPH resources and programs.

Report a disease, learn about “meaningful use,” healthy pregnancy resources and research health data and statistics.

Low THC Oil Registry DPH, in close consultation with the Georgia Composite Medical Board, has developed a Low THC Oil Registry for patients and caregivers who qualify to carry an identification card under Georgia House Bill 1.
Got Transition The Center for Health Care Transition Improvement’s resource guide for youth to adult care.
Health Alert Network Sign up for the Centers for Disease Control and Prevention’s email updates and/or RSS Feed for urgent public health incidents.
Hepatitis C Testing Toolkit for Primary Care Providers The Georgia Department of Public Health has developed a Hepatitis C Toolkit for Primary Care Providers to increase efforts to promote hepatitis C testing in high risk individuals as well as one-time hepatitis C testing for those born between 1945 and 1965. Early hepatitis C testing can allow patients to be linked to care and treatment before developing serious complications from liver damage as well as reducing transmission of hepatitis C to others.
Online Analytical Statistical Information System (OASIS) The Georgia Department of Public Health’s data warehouse for public health and public policy data analysis.
Preconception Care Toolkit Assessment and education online tools to support primary care providers to integrate preconception healthcare services with the women’s routine primary healthcare.
POLST The latest version of the Physician Orders for Life-Sustaining Treatment (POLST) Form