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Show unrelenting presence of the program in the public eye through the media. A poll done by Dan Jones and Associates indicated that over 92% of people in Utah recognized the Baby Your Baby program. That kind of penetration into the market is almost without precedent. The specific use of PSAs during prime time, when so many potential patients are watching television, is very important. Dan (1992) suggests that the less affluent watch television more than their affluent neighbors. This helps to target the exact population at risk for the potential complications of pregnancy, especially those without appropriate prenatal care. Potential Improvements to the Program The overall impact of Baby Your Baby is overwhelmingly positive. The following observations in no way detract from the successes described above. Nonetheless, the hope is that these or similar recommendations are incorporated into the program to produce an even more positive outcome. 1. System overload. From time to time, especially on the hotline, there were more patients than could be accommodated. This probably resulted in some unreturned calls and unanswered questions. On some occasions, there were long waits to obtain an obstetric appointment. No doubt, some of the patients may have been skeptical about the sincerity of the program when they found out that it would be several days or weeks to months until they would be seen. This would seem to be in opposition to the intended point of early access to prenatal care. Suggested Solution: A backup system of available physicians could see the buildup of patients caused by a particularly successful PSA or in response to the half hour documentary television programs. If the patient could not be seen rather immediately, perhaps a physician or certified nurse midwife could call the patient and answer questions. At the same time, the caller could do a screening interview to determine if the patient really did need to be seen sooner. The system might have to be expanded (by obtaining more providers) to be able to meet this goal. 2. Ethnic diversity. Utah is unique in having relatively small minority populations. Still within some of those groups, there are significant cultural barriers to prenatal care. Among the barriers is the hurdle of different languages. Information needs to be presented at least in the common languages that would be encountered in the under-served population of Utah. These include Spanish, certain Native American languages (Navajo, Ute, etc.), some Polynesian dialects, Vietnamese, Tibetan, and Russian. Other obstacles are customs of the native land from which the patient originates, and lack of familiarity with the American health care system. Suggested Solution: The hotline could be used by the providers to find people who speak the necessary language and who would be available around the clock to translate. If large groups of some particular ethnic background were to converge on a single practitioner, the practitioner should be able to get some information about the culture from which the patients arise. Conversely, the patients might be able to use the same individuals to learn more about the health care delivery system in Utah. This two-way facilitation would enhance the interaction between patients and their caregivers. 3. Incentives to providers. Traditionally low rates at which Medicaid providers in Utah are paid act as a significant negative factor in attracting physicians to see patients. There is also a pervasive perception that Medicaid patients are more likely to sue and are sicker than the average pregnant patient. Suggested Solution: Better rates of payment will be a major incentive for physicians to accept these patients into their practices. Factual data on the incidence of lawsuits as well as the case mix index for these patients could be disseminated to all potential doctors and midwives who may care for these patients. Physicians who see a disproportionate share of such patients could be paid a Utah's Health: An Annual Review 1993 121 |