Best Practice Sites in North Carolina - Check Them Out!

There are many clinics and health care systems who have been working steadily to incorporate 17P into their daily practice. Given the special circumstances presented by 17P as a compounded drug that must be administered by a health care provider, hats are off to many creative and persistent administrators and clinicians around the state for making this work. We have come across two projects who moved very quickly to put into place strong 17P programs. As you'll see from their stories, two important elements for 17P project success are nurse champions and strong partnerships between public health departments and high-risk care centers. Want to learn more? Read their profiles below.

Reducing the Risk of Recurring Preterm Birth with 17P

In June 2006 the North Carolina General Assembly appropriated $150,000 in nonrecurring funds to reduce preterm birth by improving access to and appropriate use of 17 alpha hydroxyprogesterone caproate (17P). The appropriation was used to expand education for physicians and consumers about 17P as well as to increase access to the medication by making it available to low-income women free of charge. The 17P Project was born out of the concern of many about the increasing numbers of babies being born too soon in our state. The North Carolina General Assembly provided $97,000 in funding for this project for fiscal year 2007-2008 and again for fiscal year 2008-2009. The appropriate was decreased because North Carolina Medicaid agreed in April 2007 to reimburse for 17P. This decision shows their dedication to improving birth outcomes in our state. Many thanks are due to the NC Child Fatality Task Force for their leadership in securing support for this project.

Premature birth is a complex issue. A range of activities must take place in North Carolina to address prematurity. The 17P project provides one important tool in the fight against preterm birth.

The 17P project has distributed over 2,000 vials of  17P across North Carolina. Hundreds of  health care providers and clinics have prescribed 17P for patients. Leaders in health care and in communities continue to come forward to promote this important prevention opportunity.

Project Goal

All women in North Carolina who meet the clinical criteria for 17P will have access to this intervention to reduce their risk of a recurring preterm birth.

Project Protocol

Women eligible for 17P through this project must meet the following criteria:

  • Have a history of a previous singleton spontaneous preterm birth between 200 and 366 weeks gestation.
  • Have a current singleton pregnancy.
  • Initiate treatment between 160 and 216 weeks gestation. Of note, since this population may experience barriers which result in late entry to prenatal care, an exception for treatment initiation may be made up to 236 weeks for this subset of high-risk women.

Project Collaborators

Members of the Project's Advisory Council have been integral to making the 17P project happen. The Division of Public Health and the Division of Medical Assistance have also played very key roles in moving 17P into practice.If you are interested in joining our efforts, please contact Sarah Verbiest at 919-843-7865 or sarah_verbiest@med.unc.edu.

17P Video

The 17P Project also has developed an educational video about reducing the risk of recurring preterm birth. The video features comments from mothers who have taken 17P as well as detailed information from physicians about the use of this medication. To view this video online, please click here. To view the video full screen on your computer click on the real player button. Having problems? Give us a call at 919-843-7865 or 919-843-7864.

Click here to access a 3 minute video clip that describes the 17P Project.

Project Deliverables

  • Coordinate with an Advisory Group of maternal fetal medicine specialists, obstetricians, and other stakeholders to provide leadership and guidance to the project.
  • Create access to 17P by using funds to allow obstetricians serving low-income, minority pregnant women to order free medication for their patients who fit the protocol for its use.
  • Increase awareness among health care providers, consumers, and communities about the availability of 17P, the appropriate conditions for its use, and the impact the drug could have on reducing preterm birth.
  • Document additional barriers to 17P and work with Advisory Group and other partners to consider options for addressing these issues.
  • Provide ongoing technical assistance to clinics, providers and communities in regard to 17P.

Project Impact

Weekly injections of 17P from about 16 weeks gestation onward reduces the risk of a repeat preterm birth by 33%. North Carolina Medicaid NICU costs for infants born weighing less than 2500 grams totaled $120M (43% of Medicaid costs for newborns). A cost effectiveness analysis has been conducted and has shown that 17P offers significant cost savings. Using a model developed by the March of Dimes, it is estimated that about 358 premature births could be averted with correct use of 17P. Many other infants may gain several weeks in utero - time that is very important when every day counts.

17P in the News!

Click here to access an article posted to the National Conference of State Legislators about the NC 17P Project.

Click here to access a letter presented to the House of Representatives with references to preterm birth and 17P.

Coming in July 2008 - Carolina Parent will have a story about 17P.

APHA Presentation about 17P

On November 6th the 17P program will get more national recognition at the American Public Health Association Annual Conference. To view the powerpoint slides to be presented click here. Information about the project will also be shared at the North Carolina / South Carolina Perinatal Association Conference in Greensboro.