Category:Women's Health

From Guide to YKHC Medical Practices
Jump to navigation Jump to search

Overview

Each clinic does Women’s Health Care as able, including PAP smears, breast exams, IUD Implanon placements/removal, and endometrial biopsies. There are several case managers who help with women’s health (see attached list). YKHC has a CDC Breast and Cervical Health Grant that helps YK bring in patients for PAP smears, annual exams and cancer diagnosis of breast or cervical or uterine cancer. The grant will pay for travel, meals and lodging if necessary for any women between the ages of 21-64.

The current YKHC PAP guideline suggests no PAP under 21 and then Q 3 years after that until 30. At 30 years – 65 years of age they need paps Q 5 years—as long as there is no hx of abnormalities.

We now use liquid PAPs (see LAB section). If abnormal PAPs, they are followed on a database by the CDC Breast and Cervical Care Manager: Nina Jones RN. We follow the ASCCP guidelines for dealing with abnormal PAPs. There is a great app for it on your smart phone.

Any abnormal looking cervixes, endometrial biopsies and skin lesion removals in the perineum that you feel need further work up, can be referred to Women’s Health in Bethel. Feel free to contact the Gynecology Case Manager for that @ 543-6557. Mammograms can begin at age 40 but, our current YKHC guideline is to start at age 45 and do them every 2 years.

For annual exams, you can use Well Woman’s encounter pathway note. Please make sure to document Family History, Procedure History and give Birth Control.

If you have a patient with an abnormal breast exam she will need a mammogram and a breast ultrasound, both must be done prior to the surgeon seeing them. You need to clearly document where the mass is. If she is under 40 they will only do a sono. If she is over 40 they will do both a sono/mammo.

All referrals to ANMC surgery, whether to see the general surgeon in Bethel, in Specialty Clinic and/or a surgeon in Anchorage, need to have a phone consult with an ANMC surgeon and be documented on the specialty referral form. The WH Grant Case Manager (543-6296) will make sure that copies of the mammogram and sono go to ANMC for review prior to the patient’s visit.

Women’s Health Grant Info

CDC Breast and Cervical Health Grant

This grant helps YK bring in patients for PAP smears, annual exams, and cancer diagnosis of breast or cervical or uterine cancer. The grant will pay for travel, meals and lodging if necessary for any women between the ages of 21-64.

Women’s Health (WH) Grant Info for PAPs & Mammograms

The WH Grant will fund trips to Anchorage for breast biopsy or LEEP procedure, but not for other OB/GYN related issues or surgeries.

The Women's Health Grant is funded by the CDC and is not associated with YKHC. They only fund for certain appointments or follow-ups. These appointments are for Annual PAPs, Mammograms and any abnormal follow-ups. But this differs as to exactly what age the patient is.

Age Women’s Health Grant Pays For . . . .
21-19 PAP every three years since last exam (subject to change)
30-64 PAP q5 years, Mammogram q2 years - five years since last exam
50-64 PAP q5 years or sooner for F/U, Mammogram q2 years
>64 No coverage from the grant

Any abnormal Mammos or PAP follow-ups will also be paid for by the Grant.

Any questions please feel free to call Grant Supervisor Roxanne Andersen Ext: 6696

Case Manager Christina Jones RN Ext 6296

WH Grant Admin Assistant: Ext 6990

Women’s Health Contact Information

Prenatal Case Manager

Ann Glasheen WHNP Phone 543-6305 Fax 543-6689 for questions regarding HROB patients, Labs, medications.

Prenatal Case Manager’s Secretary

Rebecca Martins Phone 543-6189 Fax 543-6689 for prenatal questions/Be-In-Bethel questions/appointments, info on prenatal appointments and Anchorage appointments.

OB/GYN Case Manager

Brenda A. Lamont, RN Phone 543-6557 Fax 543-6689 for OB/GYN referrals, 17 hydroxy-progesterone medication questions.

Women’s Health Grant Care Manager

Christina Jones, RN Phone 543-6296 Fax 543-6689 for Women’s Health Grant questions, Colpo questions/scheduling, PAP, breast, mammogram follow-up questions

Women’s Health Grant Secretary

Phone 543-6990 Fax 543-6689 for Women’s Health Grant appointments, Women’s Health Grant application/questions, OB/GYN appointments (ONLY after a referral has been made)

Midwifery In Rural Alaska: A 1994 article by former YKHC midwife Joan Koval. Still relevant today. PDF will open in your browser. Click your browser's back button to return to the wiki. Link the Joan Koval article here it is in the women’s health folder…

Prenatal Information

OB Case Managers are the primary resource for the prenatal paperwork. We have a large number of pregnant patients, many who are high risk due to chronic HTN or preeclampsia. Please at the top of each HPI for a pregnant women put a summary sentence like this example.

Pt is a 32 yr old G5P3 AB1 with an EDC of 12/25/17 at 22 weeks gestation with a history of Cholestasis of Pregnancy and Kell Antibodies.

To document prenatal visits use "OP PC Prenatal Visit Note."

There are several auto-text that should be used when documenting a prenatal or 1st prenatal visit. These all start with "..ob" (case sensitive). The "..ob1stpnhpi" is particularly important to include for 1st Prenatal visits.

At the first prenatal visit you will also need to complete the 1st Prenatal Visit ad hoc form and copy the textual rendition of this form to your HPI.

  • You should only open one 1st Prenatal Visit ad hoc form for each pregnancy.
  • If you need to add or modify information, you should go to the Form Browser, find the 1st Prenatal Visit ad hoc form for the current pregnancy, right click and select Modify.

Prenatal Appointment Schedule if Uncomplicated

Q4 week: Appts until 32 weeks
Q2 week: Until be-in-Bethel Date
Q1 week: Appts in Bethel and/or Anchorage

Prenatal Labs/Sono Needed

1st prenatal(If in SRC do labs): CBC, HepBxAg, RPR, CCUA and urine culture, GC/CT, Rubella, PPD (see PowerPlan). Make Bethel appt. for 1st trimester sono. We want a sono as early as possible on everyone.
11-13 weeks: If Advanced Maternal Age, 35 or older, first trimester screening for Down’s. Contact Ann Glasheen for particulars.
15-21 weeks: Do Quad screen
18-24 weeks: Make a 2nd Sono appt. in Bethel for Anatomy screen
24-28 weeks: Prenatal with CBC/GST. If the GST is over 140, will need a GTT ASAP.
36 weeks: Into Bethel and/or Anchorage, CBC, GC/CT, and GBS culture

Referrals

Refer GYN EXTERNAL

for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond

  • Important things to remember or talk with patients about:
    • If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
    • We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

Refer GYN INTERNAL

for patients you want Dr. Compton to see for a consultation in the clinic

  • These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
  • Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

Refer OB/GYN Surgery Internal Cleared

  • This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
  • Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
  • If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
  • Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
  • Make sure you complete all of the information and call or message Dr. Compton if you have questions.
  • If you cannot reach Dr. Compton, contact Brenda Lamont.

Sexually Transmitted Infections

We have a lot of STI’s in the Delta region.

Due to high levels of STIs, it is recommended that we aggressively screen all females AND males => 12 years of age.

When someone asks for a STI check, please do urine, self vaginal or anal swab, or cervical GC/CT, RPR, and HIV tests. Ask if they are interested in Hep B, C and Herpes (HSV1/HSV2) testing as well. When doing the urine STI test, it needs to be done with dirty urine without wiping beforehand. Use the AMB STI PowerPlan which has all testing, treatments, etc.

All positive STI tests will go to the Community Case Manager (CCM) to fill out the required Partner Information forms and follow-up with the patient regarding treatment. The provider should order any required medications and send a message to the CCM.

We use Expedited Partner Therapy on anyone who is positive for GC or CT screening. They will either come to the hospital, or go to the village clinic to receive their treatment. They will also get the number of bags of medications for the number of partners they have. A Partner Notification Sheet needs to be filled out so public health knows who was treated.

Frequently Asked Questions

What if the patient is allergic to Cefixime or azithromycin?
Contact Dr. Compton, Dr. Bowerman or an infectious disease specialist at ANMC. Be absolutely sure that the patient is truly allergic. If they are TRULY allergic to all penicillins and cephalosporins, give Azithromycin 2gm orally. It is very important to treat with 2 drugs if possible. If you are not sure, call one of the above for guidance.
What if the patient is only a contact?
Get the appropriate testing for STIs. Do a pharyngeal, genital and anal test as needed. Treat for the appropriate STI as a contact. DO NOT treat their partners.
Has the patient been previously treated? How can I tell?
Please check the MAR, medications and notes for evidence of treatment. Make sure that you set the filter on your medications for All Medications All Statuses. Make sure that you set the MAR dates to include the dates in questions.
When do you recommend an HIV or RPR?
If the patient has a negative HIV and RPR within the past 6 months they do not need a repeat. We want to strongly encourage those without a recent test to get tested.
What if the patient answers yes to anal or oral sex? Do I change the treatment?
If the patient answers yes to having anal or oral sex, perform the appropriate swabs or find a provider to help. They will need to be state lab tests. Treat with the azithromycin and/or Cefixime. Wait for a positive test to treat with different medications.

Anal and Oral GC/CT goes to State Lab

HROB Stickers--Problems/Plans

Pregnancy Termination

If a patient desires a termination, please have them come to Bethel ASAP so they can get a sonogram. Once they have had a sonogram, we can facilitate having them apply for emergency Medicaid if they still desire a termination. The patient will need to make their own appointment in Anchorage for a termination. If they are past 13 6/7 weeks, the termination cannot be done in Anchorage and the patient will have to fly to Seattle to go to the Cedar Valley Clinic in Renton WA. Medicaid will still pay for it, but they will need to apply for the emergency Medicaid so it can be done before it’s too late in the pregnancy to fill out.

There is an information packet they can be given.

What is an abortion?
It is the termination of a pregnancy. It can be done medically (abortion pills) or surgically in a clinic setting. All pregnancies are confirmed by doing a dating sonogram prior to either procedure.
Is abortion legal?
Yes. Abortion was made legal in Alaska in 1971. In 1973 the Supreme Court decision known as Roe vs. Wade legalized abortion throughout the United States. The Supreme Court has mandated some restrictions on abortion practices, which vary state to state. In the state of Alaska, a termination can be performed prior to 13 weeks and 6 days from the FIRST day of your last menstrual period. Some clinics in Alaska will only perform an abortion up to 12 weeks. Over 13 weeks patients will need to travel to Seattle, Washington.
Are there risk factors?
Yes. As with any medical procedure, there are always some risks involved. Your provider at the clinic you choose will explain these risks to you in detail at your appointment.
What is the difference between a medical and surgical abortion? What is the cost?
A medical abortion can be done from 4-8 weeks from the first day of your last period. Whether you are considered a candidate for this type of abortion is totally left to the discretion of the clinic you choose. If you are traveling from rural Alaska, you will need to stay in Anchorage or Seattle for at least 2-3 days because follow up in the clinic is necessary.

The cost varies in each clinic and if you choose to have additional sedation or pain medication, it may require an additional fee. The average cost is $650-$1500 for either type of abortion. It is always YOUR responsibility to ask about the fees.

What should I do for my appointment?
Wear comfortable clothing, a two piece outfit that will allow easy access to your arm while blood pressures are being monitored. DO NOT CONSUME ALCOHOL, ASPIRIN PRODUCTS, OR USE ANY RECREATIONAL DRUGS 24 HOURS BEFORE YOUR APPOINTMENT. If possible, decrease or eliminate all tobacco products including cigarettes and chew. Ask the clinic what you may eat/drink before this procedure and if you may continue to take your regular daily medications or vitamins.
Are there any websites to explore more information concerning abortion?
Yes. An Alaskan organization which offers reproductive choices is The Alaska Pro-Choice Alliance. Their website is: http://www.alaskaprochoice.org. Further information is through the state of AK. http://www.hss.state.ak.us/dph/wcfh/informedconsent/default.htm. Another non local organization is the Feminist Women’s Health Center which provides reproductive health information. Their website is: http://www.fwhc.org/abortion/index.htm.
What if I have difficulty with my decision AFTER the abortion is over?
Each clinic is different, but post abortion counseling may be included as part of the original fee. Please clarify this BEFORE your appointment. Some websites you may want to explore include: http://www.4exhale.org and http://www.peaceafterabortion.com
Do I have other options besides abortion?
Yes. You could also consider adoption as an alternative option to abortion. See these websites for more information or contact your provider or the Social Worker at your local hospital. http://www.americanadoptions.com/Alaska or http://www.cssalaska.org/html/programs/adoption-services.php
How do I make an appointment for an abortion?
If you have private insurance or you will self-pay, you may call and schedule your appointment. If you have no means to pay, you should see if you are eligible for Alaskan Medicaid by applying for Emergency Medicaid. You will need to have your Alaskan Medicaid number BEFORE you can call and make an appointment. The clinics that are available for this procedure are below.

Contacts

In the State of Alaska, (must be less than 13 weeks pregnant).

Colleen Murphy, MD
4231 Lake Otis Parkway
Anchorage, AK 99508
907-563-7228 Fax: 907-563-6278

Susan Lemagie, MD
425 E. Dahlia, Suite J
Palmer, AK 99645
907-745-8379 Fax: 907-745-0153
(Does not accept Medicaid)
(up to 12 weeks gest. Est: $1440.00)

Planned Parenthood of Alaska-Anchorage
4001 Lake Otis Parkway
Anchorage, AK 99508
907-563-2229 Fax: 907-563-7419
1-800-769-0045

Michael Merrick, MD
416 Frontage Road, Suite 400
Kenai, AK 99611
907-283-5487 Fax: 907-283-6062
(Patient must stay in area)
(up to 12 weeks gest. Est: $700-800)

Alaska Women’s Health Services
4100 Lake Otis Parkway
Anchorage, AK 99508
907-563-7228

If you are more than 13 weeks pregnant:

Cedar River Clinic
263 Rainier Ave. South, Suite 200
Renton, Washington 98057
1-800-572-4223 or 425-255-0471
Fax: 425-255-0262

This category currently contains no pages or media.