Team-Based Breastfeeding Support at a Federally Qualified Health Center: Efficacy, Utilization, and Patient...

A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies have assessed efficacy in socioeconomically and racially diverse communities. Following implementation of team-based LC/PCP care at a Federally Qualified Health Center (FQHC), quality improvement efforts assessed utilization, breastfeeding rates, and patient satisfaction. A retrospective chart review examined feeding status pre- and postimplementation. Analysis compared feeding rates at the 2-week, 2-month, 4-month, and 6-month well visits (well child care). Subanalysis of patients who initiated breastfeeding postimplementation examined feeding status and LC support. Patient survey evaluated satisfaction. Among patients who initiated breastfeeding, those who received a LC/PCP visit were significantly more likely to be breastfeeding at 2 weeks (94% versus 80%, p = 0.004) and 4 months (68% versus 45%, p = 0.01). However, breastfeeding rates for the whole practice were not significantly different before and after implementation. Seventy-two percent of breastfeeding families saw a LC (n = 204). Median LC visit per breastfeeding patient was 1.18 (standard deviation [SD] +1.2). Patient survey reported that the three most commonly helpful aspects of the visit were "latch instruction" (60%), "breastfeeding questions answered" (80%) and "learning about massage and hand expression" (50%). Team-based LC/PCP care is feasible at a FQHC. Patients found it helpful. Among families who initiated breastfeeding, receiving LC/PCP care was associated with increased breastfeeding duration through 4 months.