Translating Team-Based Breastfeeding Support into Primary Care Practice

J Am Board Fam Med. 2019 Nov-Dec;32(6):818-826. doi: 10.3122/jabfm.2019.06.190118.


Background: Team-based care facilitates efficient, evidence-based, patient-centered practice. An outpatient, integrated lactation consultant (LC) and primary care provider (PCP) model improves breastfeeding support, yet practices need assistance with implementation.

Method: Based on experience with team-based breastfeeding support at a suburban practice serving mainly well-educated and privately insured families, we constructed and piloted a 6-step needs assessment that informed implementation of the model at a federally qualified health center (FQHC). Practice assessment included baseline data collection of practice newborn volume, breastfeeding intent, breastfeeding rates, provider survey, and financial variables. Postimplementation outcome measurements included provider satisfaction and visit volume.

Results: Analysis using newborn volume, breastfeeding intent, and average insurance reimbursement enabled business calculation, which estimated additional 400 visits per year and revenue to cover staff training costs. The baseline provider survey (n = 20) assessed knowledge, practice resources, and barriers. The main barriers identified to providing lactation support were "not enough time" (80%) and patients "not receiving adequate help" (80%) with 58% noting "inadequate LC staffing at the clinic." After team-based LC/PCP implementation, monthly lactation visit volume doubled. Provider postintervention assessment surveys (n = 20) demonstrated a positive response with providers reporting a perception of "providing better breastfeeding support" (100%) and that "patients had a positive breastfeeding support experience" (84%).

Conclusion: Team-based LC and PCP health care is a promising approach for delivering efficient, patient-centered, face-to-face counseling and support. Practice assessment informs financial feasibility and confirms provider interest in change. An integrated LC/PCP model can be implemented in a FQHC while enhancing patient breastfeeding support and provider satisfaction.

Keywords: Access to Health Care; Breast Feeding; Community Health Nursing; Community Medicine; Continuity of Patient Care; Counseling; Delivery of Health Care; Health Care Disparities; Health Promotion; Lactation; Needs Assessment; Newborns; Practice Management; Practice-Based Research; Preventive Medicine; Primary Health Care; Surveys and Questionnaires; Women's Health.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Breast Feeding*
  • Counseling / organization & administration
  • Evidence-Based Medicine / organization & administration
  • Female
  • Health Plan Implementation
  • Health Promotion / organization & administration
  • Health Services Needs and Demand / organization & administration*
  • Humans
  • Infant
  • Patient Care Team*
  • Patient-Centered Care / organization & administration
  • Pilot Projects
  • Postnatal Care / organization & administration*
  • Primary Health Care / organization & administration*
  • Program Evaluation
  • Young Adult