Managed Care - January 2008 - (Page 51) with the initiation of the 17P medication therapy. DISCUSSION These findings indicate that the number of 17P weekly injections is a factor for better pregnancy outcomes. High risk members with a confirmed previous history of preterm birth who have at least five injections during the course of their pregnancy benefit from 17P therapy. There was no noted significant difference in outcomes between members who received the injections from 16 to 21 weeks and members who received the injections from 22 to 34 weeks in this study. The strength of this study is its design, which includes patients who are typical members in a managed Medicaid population. The results are statistically significant for reduction in NICU admissions, and the population size is sufficient to make this conclusion. There is potential for bias in this study. Specifically, members who were compliant with their 17P injections may also have tended to be more compliant with other aspects of prenatal care, compared to those members who were not compliant and as a result received fewer than five injections. Whether the differences in the birth outcomes of members who received five or more injections versus those who received fewer than five injections are attributable to inherent differences between the groups’ general approaches to pregnancy or differences in prenatal care are not addressed by this study. The literature shows that offering 17P as a benefit to pregnant women enrollees with a history of preterm birth can decrease NICU days significantly for a Medicaid managed care population (Mason 2005). Our results are consistent with the results of a double blind, randomized, placebo-controlled trial FIGURE 1 Initiation of treatment 90 80 70 60 50 40 30 20 10 0 NICU admissions GA < 37 weeks 16–21 weeks 22–34 weeks Percentage of occurence GA < 32 weeks Deaths Outcomes completed by Meis and colleagues (2003). In the Meis study, treatment with 17P significantly reduced the risk of delivery to 36.3 percent at fewer than 37 weeks and to 11.4 percent at fewer than 32 weeks. In the present study, the intervention group which had at least five injections of 17P had a 42.8 percent rate of preterm birth between 33 and 37 weeks and a preterm birth rate of 13.1 percent at fewer than 32 weeks, despite the significant challenges that exist in extending the 17P benefit to this population. Delays in approval and notification of eligibility for managed Medicaid for pregnant FIGURE 2 Total Injections 90 80 70 60 50 40 30 20 10 0 NICU admissions Percentage of occurence women and in getting access to prenatal care make it difficult to initiate 17P injections in high-risk women who are suitable candidates for such treatment within the recommended time frames. The injections are scheduled weekly, so compliance also becomes an issue because of social barriers encountered by this population. Other than offering 17P as a covered benefit, we are not aware of any external reasons that might have caused any decreases in the rate of NICU admission or the rate of preterm delivery. The effects of delaying the initi- Injections ≥5 <5 GA < 37 weeks GA < 32 weeks Deaths Outcomes JANUARY 2008 / MANAGED CARE 51
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