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Phillips SEK, Celi AC, Margo J, Wehbe A, Karlage A, Zera CA. Improving Care Beyond Birth: A Qualitative Study of Postpartum Care After High-Risk Pregnancy. J Womens Health (Larchmt) 2024. [PMID: 38860345 DOI: 10.1089/jwh.2024.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Background: The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care. Methods: This is a qualitative study of high-risk pregnant and postpartum individuals. We conducted in-depth interviews with 20 high-risk pregnant or postpartum people. Interviews explored personal experiences of postpartum care planning, coordination of care between providers, and patients' perception of ideal care transitions. We performed thematic analysis using the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change as a framework. COM-B allowed for a formal structure to assess participants' ability to access postpartum care and primary care reengagement after delivery. Results: Participants universally identified difficulty accessing primary care in the postpartum period, with the most frequently reported barriers being lack of knowledge and supportive environments. Insufficient preparation, inadequate prenatal counseling, and lack of standardized care transitions were the most significant barriers to primary care reengagement. Participants who most successfully engaged in primary care had postpartum care plans, coordination between obstetric and primary care, and access to material resources. Conclusions: High-risk postpartum individuals do not receive effective counseling on the importance of primary care engagement after delivery. System-level challenges and lack of care coordination also hinder access to primary care. Future interventions should include prenatal education on the benefits of primary care follow-up, structured postpartum planning, and system-level improvements in obstetric and primary care provider communication.
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Affiliation(s)
- Sara E K Phillips
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ann C Celi
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Divisions of General Medicine and Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Judy Margo
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexandra Wehbe
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ami Karlage
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chloe A Zera
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Mehta A, Spitz J, Sharma S, Bonomo J, Brewer LC, Mehta LS, Sharma G. Addressing Social Determinants of Health in Maternal Cardiovascular Health. Can J Cardiol 2024; 40:1031-1042. [PMID: 38387722 DOI: 10.1016/j.cjca.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the number-one cause of maternal mortality, with over two-thirds of cases being preventable. Social determinants of health (SDoH) encompass the nonmedical social and environmental factors that an individual experiences that have a significant impact on their health. These stressors disproportionately affect socially disadvantaged and minority populations. Pregnancy is a physiologically stressful state that can unmask underlying CVD risk factors and lead to adverse pregnancy outcomes (APOs). Disparities in APOs are particularly pronounced among individuals of color and those from economically disadvantaged backgrounds. This variation underscores healthcare inequity and access, a failure of the healthcare system. Besides short-term negative effects, APOs also are associated strongly with long-term CVDs. APOs therefore must be identified as a cue for early intervention, for the prevention and management of CVD risk factors. This review explores the intricate relationship among maternal morbidity and mortality, SDoH, and cardiovascular health, and the implementation of health policy efforts to reduce the negative impact of SDoH in this patient population. The review emphasizes the importance of comprehensive strategies to improve maternal health outcomes.
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Affiliation(s)
- Adhya Mehta
- Department of Internal Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | - Jared Spitz
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - Sneha Sharma
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jason Bonomo
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laxmi S Mehta
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA.
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Green HM, Williams B, Diaz L, Carmona-Barrera V, Davis K, Feinglass J, Kominiarek MA, Dolan BM, Grobman WA, Yee LM. Evaluating feedback from an implementation advisory board to assess the rollout of a postpartum patient navigation program. Implement Sci Commun 2024; 5:50. [PMID: 38702751 PMCID: PMC11067255 DOI: 10.1186/s43058-024-00589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Patient navigation is an individualized intervention to facilitate comprehensive care which has not yet been fully implemented in obstetric or postpartum care. METHODS We aimed to develop and evaluate a mechanism to incorporate feedback regarding implementation of postpartum patient navigation for low-income birthing individuals at an urban academic medical center. This study analyzed the role of an Implementation Advisory Board (IAB) in supporting an ongoing randomized trial of postpartum navigation. Over the first 24 months of the trial, the IAB included 11 rotating obstetricians, one clinic resource coordinator, one administrative leader, two obstetric nurses, one primary care physician, one social worker, and one medical assistant. Members completed serial surveys regarding program implementation, effects on patient care, and areas for improvement. Quarterly IAB meetings offered opportunities for additional feedback. Survey responses and meeting notes were analyzed using the constant comparative method and further interpreted within the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. RESULTS Members of the IAB returned 37 surveys and participated in five meetings over 24 months. Survey analysis revealed four themes among the inner context: reduced clinician burden, connection of care teams, communication strategies, and clinic workflow. Bridging factors included improved patient access to care, improved follow-up, and adding social context to care. Innovation factors included availability of navigators, importance of consistent communication, and adaptation over time. Meeting notes highlighted the importance of bidirectional feedback regarding implementation, and members expressed positive opinions regarding navigators' effects on patient care, integration into clinic workflow, and responsiveness to feedback. IAB members initially suggested changes to improve implementation; later survey responses demonstrated successful program adaptations. CONCLUSIONS Members of an implementation advisory board provided key insights into the implementation of postpartum patient navigation that may be useful to promote dissemination of navigation and establish avenues for the engagement of implementing partners in other innovations. TRIAL REGISTRATION ClinicalTrials.gov, NCT03922334 . Registered April 19, 2019. The results here do not present the results of the primary trial, which is ongoing.
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Affiliation(s)
- Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
| | - Brigid M Dolan
- Division of General Internal Medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, 43221, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, USA.
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Clapp MA, Ray A, Liang P, James KE, Ganguli I, Cohen J. Increasing Postpartum Primary Care Engagement through Default Scheduling and Tailored Messaging : A Randomized Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.21.24301585. [PMID: 38633772 PMCID: PMC11023680 DOI: 10.1101/2024.01.21.24301585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Over 30% of pregnant people have at least one chronic medical condition, and nearly 20% develop gestational diabetes or pregnancy-related hypertension, increasing the risk of future chronic disease. While these individuals are often monitored closely during pregnancy, they face significant barriers when transitioning to primary care following delivery, due in part to a lack of health care support for this transition. Objective To evaluate the impact of an intervention designed to improve postpartum primary care engagement by reducing patient administrative burden and information gaps. Design Individual-level randomized controlled trial conducted from November 3, 2022 to October 11, 2023. Setting One hospital-based and five community-based outpatient obstetric clinics affiliated with a large academic medical center. Participants Participants included English- and Spanish-speaking pregnant or recently postpartum adults with obesity, anxiety, depression, diabetes mellitus, chronic hypertension, gestational diabetes, or pregnancy-related hypertension, and a primary care practitioner (PCP) listed in their electronic health record (EHR). Intervention A behavioral economics-informed intervention bundle, including default scheduling of postpartum PCP appointments and tailored messages. Main Outcome Completion of a PCP visit for routine or chronic condition care within 4 months of delivery. Results 360 patients were randomized (Control: N=176, Intervention: N=184). Individuals had mean (SD) age 34.1 (4.9) years and median gestational age of 36.3 weeks (interquartile range (IQR) 34.0-38.6 weeks) at enrollment. The distribution of self-reported races was 7.4% Asian, 6.8% Black, 15.0% multiple races or "Other," and 68.6% White. Most (75.8%) participants had anxiety or depression, 15.9% had a chronic or pregnancy-related hypertensive disorder, 19.8% had pre-existing or gestational diabetes, and 40.4% had a pre-pregnancy BMI ≥30 kg/m2. Medicaid was the primary payer for 21.9% of patients. PCP visit completion within 4 months occurred in 22.0% in the control group and 40.0% in the intervention group. In regression models accounting for randomization strata, the intervention increased PCP visit completion by 18.7 percentage points (95%CI 10.7-29.1). Intervention participants also had fewer postpartum readmissions (1.7 vs. 5.8%) and increased receipt of the following services by a PCP: blood pressure screening (42.8 vs. 28.3%), weight assessment (42.8 vs. 27.7%), and depression screening (32.8 vs. 16.8%). Conclusions and Relevance In this randomized trial of pregnant individuals with or at risk for chronic health conditions, default PCP visit scheduling, tailored messages, and reminders substantially improved postpartum primary care engagement. The current lack of support for postpartum transitions to primary care is a missed opportunity to improve recently pregnant individual's short- and long-term health. Reducing patient administrative burdens may represent relatively low-resource, high-impact approaches to improving postpartum health and wellbeing. Trial Registration NCT05543265.
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Affiliation(s)
- Mark A Clapp
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alaka Ray
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Kaitlyn E James
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ishani Ganguli
- Harvard Medical School, Boston, MA
- Brigham & Women's Hospital, Boston MA
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Xue Z, Zhang Y, Gan W, Wang H, She G, Zheng X. Quality and Dependability of ChatGPT and DingXiangYuan Forums for Remote Orthopedic Consultations: Comparative Analysis. J Med Internet Res 2024; 26:e50882. [PMID: 38483451 PMCID: PMC10979330 DOI: 10.2196/50882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The widespread use of artificial intelligence, such as ChatGPT (OpenAI), is transforming sectors, including health care, while separate advancements of the internet have enabled platforms such as China's DingXiangYuan to offer remote medical services. OBJECTIVE This study evaluates ChatGPT-4's responses against those of professional health care providers in telemedicine, assessing artificial intelligence's capability to support the surge in remote medical consultations and its impact on health care delivery. METHODS We sourced remote orthopedic consultations from "Doctor DingXiang," with responses from its certified physicians as the control and ChatGPT's responses as the experimental group. In all, 3 blindfolded, experienced orthopedic surgeons assessed responses against 7 criteria: "logical reasoning," "internal information," "external information," "guiding function," "therapeutic effect," "medical knowledge popularization education," and "overall satisfaction." We used Fleiss κ to measure agreement among multiple raters. RESULTS Initially, consultation records for a cumulative count of 8 maladies (equivalent to 800 cases) were gathered. We ultimately included 73 consultation records by May 2023, following primary and rescreening, in which no communication records containing private information, images, or voice messages were transmitted. After statistical scoring, we discovered that ChatGPT's "internal information" score (mean 4.61, SD 0.52 points vs mean 4.66, SD 0.49 points; P=.43) and "therapeutic effect" score (mean 4.43, SD 0.75 points vs mean 4.55, SD 0.62 points; P=.32) were lower than those of the control group, but the differences were not statistically significant. ChatGPT showed better performance with a higher "logical reasoning" score (mean 4.81, SD 0.36 points vs mean 4.75, SD 0.39 points; P=.38), "external information" score (mean 4.06, SD 0.72 points vs mean 3.92, SD 0.77 points; P=.25), and "guiding function" score (mean 4.73, SD 0.51 points vs mean 4.72, SD 0.54 points; P=.96), although the differences were not statistically significant. Meanwhile, the "medical knowledge popularization education" score of ChatGPT was better than that of the control group (mean 4.49, SD 0.67 points vs mean 3.87, SD 1.01 points; P<.001), and the difference was statistically significant. In terms of "overall satisfaction," the difference was not statistically significant between the groups (mean 8.35, SD 1.38 points vs mean 8.37, SD 1.24 points; P=.92). According to how Fleiss κ values were interpreted, 6 of the control group's score points were classified as displaying "fair agreement" (P<.001), and 1 was classified as showing "substantial agreement" (P<.001). In the experimental group, 3 points were classified as indicating "fair agreement," while 4 suggested "moderate agreement" (P<.001). CONCLUSIONS ChatGPT-4 matches the expertise found in DingXiangYuan forums' paid consultations, excelling particularly in scientific education. It presents a promising alternative for remote health advice. For health care professionals, it could act as an aid in patient education, while patients may use it as a convenient tool for health inquiries.
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Affiliation(s)
- Zhaowen Xue
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiming Zhang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenyi Gan
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huajun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guorong She
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Oh J. Patient navigation in women's health care for maternal health and noncancerous gynecologic conditions: a scoping review. WOMEN'S HEALTH NURSING (SEOUL, KOREA) 2024; 30:26-40. [PMID: 38650325 PMCID: PMC11073553 DOI: 10.4069/whn.2024.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study investigated the scope of patient navigation studies on women's health care for maternal health and noncancerous gynecologic conditions and aimed to report the characteristics of the identified patient navigation programs. METHODS A scoping review was conducted following Arksey and O'Malley's framework. Five electronic databases were searched for relevant studies published in English: PubMed, Embase, Cochrane Library, CINAHL, and PsycInfo. There were no restrictions on the publication date and the search was completed in July 2023. RESULTS This scoping review included 14 studies, which collectively examined seven patient navigation programs. All selected studies were related to maternal health issues (e.g., perinatal health problems and contraception for birth spacing). Close to two-thirds of the patient navigation services were provided by women (n=9, 64.3%) and half by lay navigators (n=7, 50.0%). The majority incorporated the use of mobile health technologies (n=11, 78.6%). All of the patient navigation programs included in the review coordinated the necessary clinical and social support services to improve women's access to care. CONCLUSION Patient navigation appears to be in its nascent phase in the field of maternal health. The results of this study suggest that the implementation of patient navigation services could potentially improve access to care for socially disadvantaged women and families. Furthermore, providing patient navigation services that are specifically tailored to meet women's needs could improve the quality of maternity care.
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Affiliation(s)
- Jiwon Oh
- College of Nursing, Sungshin Women’s University, Seoul, Korea
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Grobman WA, Entringer S, Headen I, Janevic T, Kahn RS, Simhan H, Yee LM, Howell EA. Social determinants of health and obstetric outcomes: A report and recommendations of the workshop of the Society for Maternal-Fetal Medicine. Am J Obstet Gynecol 2024; 230:B2-B16. [PMID: 37832813 DOI: 10.1016/j.ajog.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
This article is a report of a 2-day workshop, entitled "Social determinants of health and obstetric outcomes," held during the Society for Maternal-Fetal Medicine 2022 Annual Pregnancy Meeting. Participants' fields of expertise included obstetrics, pediatrics, epidemiology, health services, health equity, community-based research, and systems biology. The Commonwealth Foundation and the Alliance of Innovation on Maternal Health cosponsored the workshop and the Society for Women's Health Research provided additional support. The workshop included presentations and small group discussions, and its goals were to accomplish the following.
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Green HM, Diaz L, Carmona-Barrera V, Grobman WA, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Zera C, Yee LM. Mapping the Postpartum Experience Through Obstetric Patient Navigation for Low-Income Individuals. J Womens Health (Larchmt) 2024. [PMID: 38265478 DOI: 10.1089/jwh.2023.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334.
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Affiliation(s)
- Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Chen Yeh
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Lam AB, Moore V, Nipp RD. Care Delivery Interventions for Individuals with Cancer: A Literature Review and Focus on Gastrointestinal Malignancies. Healthcare (Basel) 2023; 12:30. [PMID: 38200936 PMCID: PMC10779432 DOI: 10.3390/healthcare12010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Gastrointestinal malignancies represent a particularly challenging condition, often requiring a multidisciplinary approach to management in order to meet the unique needs of these individuals and their caregivers. PURPOSE In this literature review, we sought to describe care delivery interventions that strive to improve the quality of life and care for patients with a focus on gastrointestinal malignancies. CONCLUSION We highlight patient-centered care delivery interventions, including patient-reported outcomes, hospital-at-home interventions, and other models of care for individuals with cancer. By demonstrating the relevance and utility of these different care models for patients with gastrointestinal malignancies, we hope to highlight the importance of developing and testing new interventions to address the unique needs of this population.
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Affiliation(s)
- Anh B. Lam
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Vanessa Moore
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Ryan D. Nipp
- Division of Hematology and Oncology, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA
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Sabloak T, Yee LM, Feinglass J. Antepartum Emergency Department Use and Associations with Maternal and Neonatal Outcomes in a Large Hospital System. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:562-570. [PMID: 38099077 PMCID: PMC10719645 DOI: 10.1089/whr.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 12/17/2023]
Abstract
Objectives Prenatal care in the United States has remained unchanged for decades, with pregnant patients often experiencing high rates of hospital emergency department (ED) visits. It is unknown how many of these ED visits are potentially preventable with better access to timely and effective outpatient or home prenatal care. This multihospital health system quality improvement study was undertaken to analyze patient risk factors for acute antepartum hospital use as well as associations with adverse maternal and neonatal birth outcomes. Methods The retrospective cohort study analyzed electronic health record and administrative data on ED visits in the 270 days before a delivery admission for alive, singleton births at nine system hospitals over 52 months. We use logistic regression to estimate the likelihood of hospital use by patient demographic and clinical characteristics and present the association of acute antepartum hospital use with maternal and neonatal birth outcomes. Results Overall, 17.5% of 68,200 patients had antepartum ED visits, including 248 inpatient admissions, with significant variation between hospitals. As compared to non-Hispanic white patients, Hispanic and especially non-Hispanic Black and Medicaid patients had significantly higher odds of acute antepartum hospital use as did patients with preexisting conditions. Birth outcomes were significantly (p < 0.01) worse among individuals with antepartum hospital utilization. Conclusion Acute antepartum hospital use was concentrated among lower income, minority patients, and those with chronic conditions with significant variation across system hospitals. There is a need for research into innovations in prenatal care that are best at reaching our most vulnerable patients, reducing preventable hospital utilization, and improving birth outcomes.
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Affiliation(s)
- Thwisha Sabloak
- Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Gamble C, Woodard TJ, Yakubu AI, Chapman-Davis E. An Intervention-Based Approach to Achieve Racial Equity in Gynecologic Oncology. Obstet Gynecol 2023; 142:957-966. [PMID: 37678907 PMCID: PMC10510810 DOI: 10.1097/aog.0000000000005348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Racial inequities within gynecologic oncology exist at every step of the cancer continuum. Although the disparities have been well described, there is a significant gap in the literature focused on eliminating inequities in gynecologic cancer outcomes. The goal of this narrative review is to highlight successful, evidence-based interventions from within and outside of gynecologic oncology that alleviate disparity, providing a call to action for further research and implementation efforts within the field. These solutions are organized in the socioecologic framework, where multiple levels of influence-societal, community, organizational, interpersonal, and individual-affect health outcomes.
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Affiliation(s)
- Charlotte Gamble
- Division of Gynecologic Oncology, MedStar Washington Hospital Center, and Georgetown University, Washington, DC; the Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia; and the Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
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12
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Öztoprak PU, Koç G, Erkaya S. Evaluation of the effect of a nurse navigation program developed for postpartum mothers on maternal health: A randomized controlled study. Public Health Nurs 2023; 40:672-684. [PMID: 37443414 DOI: 10.1111/phn.13226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE This study aimed to determine the effects of a nurse navigation program on the capability for self-care, quality of life, risk of anxiety and depression, and severity of the physical symptoms of postpartum mothers. METHODS This prospective, parallel-group, randomized controlled study included 64 primiparous pregnant women (32 women each in the intervention and control groups) at ≥36 gestational weeks admitted to the pregnancy outpatient clinic of a public hospital in Turkey. The intervention group received navigation program-based nursing care comprising three home visits, four phone calls, and five text messages aside from the standard hospital care during delivery and the postpartum period. Meanwhile, the control group received only the standard hospital care during delivery and the postpartum period. Data were collected using a sociodemographic data form, the Self-Care Power Scale, the Maternal Postpartum Quality of Life Instrument (MPQoL-I), the Postpartum Specific Anxiety Scale (PSAS), the Edinburgh Postnatal Depression Scale (EPDS), and the Postpartum Physical Symptom Severity Scale. RESULTS Mean scores for the capability for self-care and quality of life were higher, while those for the risk of depression and anxiety were lower for the intervention group than the control group (p < .05). CONCLUSIONS Navigation program-based care provided to primiparous mothers improved maternal health.
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Affiliation(s)
- Pınar Uzunkaya Öztoprak
- Department of Obstetrics and Gynecology Nursing, Hacettepe University Nursing Faculty, Ankara, Turkey
| | - Gülten Koç
- Department of Obstetrics and Gynecology Nursing, Hacettepe University Nursing Faculty, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Ankara Etlik Zübeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Ruderman RS, Dahl EC, Williams BR, Feinglass JM, Kominiarek MA, Grobman WA, Yee LM. Obstetric Provider Perspectives on Postpartum Patient Navigation for Low-Income Patients. HEALTH EDUCATION & BEHAVIOR 2023; 50:260-267. [PMID: 34636273 PMCID: PMC9086643 DOI: 10.1177/10901981211043117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. METHOD Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. RESULTS Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. CONCLUSIONS Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.
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Affiliation(s)
- Rachel S. Ruderman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emma C. Dahl
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brittney R. Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joe M. Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Melhem SJ, Nabhani-Gebara S, Kayyali R. Cancer literacy among Jordanian colorectal cancer survivors and informal carers: Qualitative explorations. Front Public Health 2023; 11:1116882. [PMID: 37020817 PMCID: PMC10067669 DOI: 10.3389/fpubh.2023.1116882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/01/2023] [Indexed: 03/22/2023] Open
Abstract
IntroductionCancer patients face a variety of challenges in understanding their diagnosis and treatment options. Making informed decisions requires health literacy. There is scant research on how colorectal cancer (CRC) survivors and their caregivers engage with healthcare systems and obtain cancer-related knowledge to maintain proper health literacy, which is crucial for enhancing their outcomes.Materials and methodsIn-depth semi-structured interviews (IDIs) with CRC survivors (n = 15) and online focus groups (FG) with informal caregivers (ICs) were held in Amman between Jan-June 2020. In-depth interviews were conducted using semi-structured interview protocol that addressed the healthcare experience of CRC cancer survivors. FGs evaluated ICs' perspectives of e-health for cancer care support. IDIs and FGs were done in the local Jordanian Arabic dialect, which was then translated into English. Transcribed audio-recordings were thematically coded and framework analysis was used.ResultsThe findings are organized around a central concept of “exploring the level of literacy and its impact.” From the overarching theme, three themes and subthemes emerged, including: (1) The current state of counseling and information provision, (2) The impact of lack of information, awareness, and literacy and (3) The health system's influence on literacy.ConclusionsPoor cancer literacy hinders patients throughout their cancer journey. Empowering cancer patients is crucial for a more timely and positive patient experience. Increased cancer literacy together with the creation of health-literate organizations and systems have the potential to improve patients' treatment throughout the continuum of care.
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Abstract
Equitable access to contraception and contraceptive education has the potential to mitigate health disparities related to unintended pregnancy. Pregnancy and the postpartum window frequently offer reduced insurance barriers to healthcare, increased interaction with healthcare systems and family planning providers, and an opportune time for many individuals to receive contraception; however, there are additional considerations in method type for postpartum individuals, and contraceptive counseling must be thoughtfully conducted to avoid coercion and promote shared decision-making. This commentary reviews method-specific considerations and suggests priorities for achieving equity in postpartum contraceptive access.
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Kumar NR, Grobman WA, Haas DM, Silver RM, Reddy UM, Simhan H, Wing DA, Mercer BM, Yee LM. Association of Social Determinants of Health and Clinical Factors with Postpartum Hospital Readmissions among Nulliparous Individuals. Am J Perinatol 2023; 40:348-355. [PMID: 36427510 DOI: 10.1055/s-0042-1758485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prior data suggest that there are racial and ethnic disparities in postpartum readmission among individuals, especially among those with hypertensive disorders of pregnancy. Existing reports commonly lack granular information on social determinants of health. The objective of this study was to investigate factors associated with postpartum readmission for individuals and address whether such risk factors differed by whether an individual had an antecedent diagnosis of a hypertensive disorder of pregnancy (HDP). STUDY DESIGN This is a secondary analysis of a large, multicenter prospective cohort study of 10,038 nulliparous participants. The primary outcome of this analysis was postpartum readmission. A priori, participants were analyzed separately based on whether they had HDP. Participant characteristics previously associated with a greater risk of perinatal morbidity or readmission (including social determinants of health, preexisting and chronic comorbidities, and intrapartum characteristics) were compared with bivariable analyses and retained in multivariable models if p < 0.05. Social determinants of health evaluated in this analysis included insurance status, self-identified race and ethnicity (as a proxy for structural racism), income, marital status, primary language, and educational attainment. RESULTS Of 9,457 participants eligible for inclusion, 1.7% (n = 165) were readmitted following initial hospital discharge. A higher proportion of individuals with HDP were readmitted compared with individuals without HDP (3.4 vs 1.3%, p < 0.001). Among participants without HDP, the only factors associated with postpartum readmission were chorioamnionitis and cesarean delivery. Among participants with HDP, gestational diabetes and postpartum hemorrhage requiring transfusion were associated with postpartum readmission. While the number of postpartum readmissions included in our analysis was relatively small, social determinants of health that we examined were not associated with postpartum readmission for either group. CONCLUSION In this diverse cohort of nulliparous pregnant individuals, there was a higher frequency of postpartum readmission among participants with HDP. Preexisting comorbidity and intrapartum complications were associated with postpartum readmission among this population engaged in a longitudinal study. KEY POINTS · Non-HDP patients had higher odds of PPR with chorioamnionitis or cesarean.. · HDP patients had higher odds of PPR if they had GDM or PPH.. · Characterizing PPR may identify and highlight modifiable factors..
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Affiliation(s)
- Natasha R Kumar
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Deborah A Wing
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Mou T, Nelson L, Lewicky-Gaupp C, Brown O. Opportunities to Advance Postpartum Pelvic Floor Care With a Health Equity-based Conceptual Framework. Clin Obstet Gynecol 2023; 66:86-94. [PMID: 36657047 DOI: 10.1097/grf.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An essential part of postpartum care includes the evaluation and treatment of pelvic floor disorders (PFDs). Postpartum PFDs are common and occur in over 40% of postpartum women. Despite significant advancements in urogynecology to understand postpartum PFDs and their treatments, there has been a lack of attention to addressing equity in postpartum pelvic floor care. In this article, we address the current scientific understanding of postpartum PFDs while adapting a health equity-based conceptual framework to highlight areas of opportunity in optimizing postpartum pelvic floor care.
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Affiliation(s)
- Tsung Mou
- Division of Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
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Green HM, Carmona-Barrera V, Diaz L, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Grobman WA, Zera C, Yee LM. Implementation of postpartum navigation for low-income individuals at an urban academic medical center. PLoS One 2023; 18:e0282048. [PMID: 36821597 PMCID: PMC9949671 DOI: 10.1371/journal.pone.0282048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Patient navigation, a patient-centered intervention to promote comprehensive health care, is an emerging innovation in obstetrics to optimize postpartum care. We aimed to evaluate the implementation of a novel postpartum patient navigation program at an urban academic medical center. METHODS This mixed-methods study analyzed the implementation of a postpartum patient navigation program within an ongoing randomized control trial. This study analyzed three navigators' logs of interactions with 50 patients, care team members, and community organizations throughout patients' first year postpartum. We categorized and quantified interactions by topic addressed, care team member interacted with, and communication mode used. We also conducted semi-structured interviews with each navigator every three months (5 interviews per navigator), emphasizing navigation experiences, relationships with patients and care teams, integration in the care team, and healthcare system gaps. Interview data were analyzed using the constant comparative method to identify themes using the constructs of the Consolidated Framework for Implementation Research (CFIR). RESULTS Analysis of navigator logs revealed a high patient need level, especially in the first 3 months postpartum. CFIR-guided analysis of intervention characteristics revealed positive perceptions of navigation's utility due to its adaptability. Navigation's complexity, however, posed an early obstacle to implementation that diminished over time. Outer setting analysis indicated navigators addressed patient needs through interactions with multiple systems. Despite clinicians' initial unfamiliarity with navigation, inner setting analysis suggested ongoing communication and electronic medical record use facilitated integration into the care team. Regarding individual and process characteristics, findings emphasized how navigator self-efficacy and confidence increased with experience (individual) and was facilitated by comprehensive training and reflection (process). Overall, barriers to implementation included unfamiliarity, varied patient engagement, and innovation complexity. Facilitators included high patient need, communication with outside organizations, medical record usage, navigator characteristics (self-efficacy, communication skills, and personal growth), a comprehensive training period, consistent reflection, high relative advantage, and high adaptability to patient need. CONCLUSION Patient navigation is a promising innovation to improve postpartum care coordination and support care team efforts. The successful implementation of navigation in this study indicates that, if shown to improve patient outcomes, obstetric navigation could be a component of patient-centered postpartum care.
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Affiliation(s)
- Hannah M. Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Chen Yeh
- Biostatistics Collaboration Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ka’Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States of America
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Peahl A, Ojo A, Henrich N, Shah N, Jahnke H. Association Between Utilization of Digital Prenatal Services and Vaginal Birth After Cesarean. J Midwifery Womens Health 2023; 68:255-264. [PMID: 36655813 DOI: 10.1111/jmwh.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Digital health services are a promising but understudied method for reducing common barriers to vaginal birth after cesarean (VBAC), including connection to facilities offering labor after cesarean and patient-centered counseling about mode of birth. This study assesses the relationship between use of digital prenatal services and VBAC. METHODS In this retrospective cohort study, we analyzed the use of digital prenatal services and mode of birth among users of an employer-sponsored digital women's and family digital health platform. All users had a prior cesarean birth. Users' self-reported data included demographics, medical history, and birth preferences. We used basic descriptive statistics and logistic regression models to assess the association between digital services utilization and VBAC, adjusting for key patient characteristics. RESULTS Of 271 included users, 44 (16.2%) had a VBAC and 227 (83.8%) had a cesarean birth. Users of both groups were similar in age, race, and ethnicity. Fewer users in the VBAC group (5/44, 11.4%) as compared with the cesarean birth group (62/227, 27.3%) had a prepregnancy body mass index greater than or equal to 30 (P = 0.02). Likewise, more users in the VBAC group preferred vaginal birth (34/44, 77.3% vs 55/227, 24.2%; P < 0.01). In adjusted models, the services associated with VBAC were care advocate appointments (adjusted odds ratio [aOR], 7.67; 95% CI, 1.99-54.4), health care provider appointments (aOR, 1.12; 95% CI, 1.02-1.25), and resource reads (aOR, 1.05, 95% CI, 1.00-1.09). VBAC rates were higher for users who reported the digital health platform influenced aspects of their pregnancy and birth. DISCUSSION Reducing cesarean birth rates is a national priority. Digital health services, particularly care coordination and education, are promising for accomplishing this goal through increasing rates of trial of labor after cesarean and subsequent VBAC rates.
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Affiliation(s)
- Alex Peahl
- Maven Clinic, New York, New York.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Ayotomiwa Ojo
- Maven Clinic, New York, New York.,Harvard Medical School, Boston, Massachusetts
| | | | - Neel Shah
- Maven Clinic, New York, New York.,Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Brown Z, Messaoudi C, Silvia E, Bleau H, Meskill A, Flynn A, Abel-Bey AC, Ball TJ. Postpartum navigation decreases severe maternal morbidity most among Black women. Am J Obstet Gynecol 2023:S0002-9378(23)00004-2. [PMID: 36610531 DOI: 10.1016/j.ajog.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Postpartum care is crucial for addressing conditions associated with severe maternal morbidity and mortality. Examination of programs that affect these outcomes for women at high risk, including disparate populations, is needed. OBJECTIVE This study aimed to examine whether a postpartum navigation program decreases all-cause 30-day postpartum hospitalizations and hospitalizations because of severe maternal morbidity identified using the US Centers for Disease Control and Prevention guidelines. The effect of this program was explored across patient demographics, including race and ethnicity. STUDY DESIGN This was a retrospective cohort study that used health records of women who delivered at 3 large hospitals in the New York metropolitan area (Queens and Long Island) between April 2020 and November 2021 and who were at high risk of severe maternal morbidity. The incidence rates of 30-day postpartum all-cause hospitalization and hospitalization because of severe maternal morbidity were compared between women who were and were not enrolled in a novel postpartum transitional care management program. Navigation included standardized assessments, development of care plans, clinical management, and connection to clinical and social services that would extend beyond the postpartum period. Because the program prioritized enrolling women of the greatest risk, the risk-adjusted incidence was estimated using multivariate Poisson regression and stratified across patient demographics. RESULTS Patient health records of 5819 women were included for analysis. Of note, 5819 of 19,258 deliveries (30.2%) during the study period were identified as having a higher risk of severe maternal morbidity. This was consistent with the incidence of high-risk pregnancies for tertiary hospitals in the New York metropolitan area. The condition most identified for risk of severe maternal morbidity at the time of delivery was hypertension (3171/5819 [54.5%]). The adjusted incidence of all-cause rehospitalization was 20% lower in enrollees than in nonenrollees (incident rate ratio, 0.80; 95% confidence interval, 0.67-0.95). Rehospitalization was decreased the most among Black women (incident rate ratio, 0.57; 95% confidence interval, 0.42-0.80). The adjusted incidence of rehospitalization because of indicators of severe maternal morbidity was 56% lower in enrollees than in nonenrollees (incident rate ratio, 0.44; 95% confidence interval, 0.24-0.77). Furthermore, it decreased most among Black women (incident rate ratio, 0.23; 95% confidence interval, 0.07-0.73). CONCLUSION High-risk medical conditions at the time of delivery increased the risk of postpartum hospitalization, including hospitalizations because of severe maternal morbidity. A postpartum navigation program designed to identify and resolve clinical and social needs reduced postpartum hospitalizations and racial disparities with hospitalizations. Hospitals and healthcare systems should adopt this type of care model for women at high risk of severe maternal morbidity. Cost analyses are needed to evaluate the financial effect of postpartum navigation programs for women at high risk of severe maternal morbidity or mortality, which could influence reimbursement for these types of services. Further evidence and details of novel postpartum interventional models are needed for future studies.
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Affiliation(s)
- Zenobia Brown
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY.
| | - Choukri Messaoudi
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Emily Silvia
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Hallie Bleau
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Ashley Meskill
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Anne Flynn
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Amparo C Abel-Bey
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
| | - Trever J Ball
- Northwell Health, Health Solutions Population Health Management, Manhasset, NY
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Kolodziej D, Wolkwitz P, Schön G, Siefert S, Pawils S. Evaluation of a Child-centred Psychosocial Healthcare Intervention (KIDPROTEKT) - Results of a Cluster Randomized Controlled Trial in Paediatric and Gynaecologic Practices. INTERVENCION PSICOSOCIAL 2023; 32:33-42. [PMID: 37361631 PMCID: PMC10268543 DOI: 10.5093/pi2023a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/11/2022] [Indexed: 06/28/2023]
Abstract
KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting.
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Affiliation(s)
- Désirée Kolodziej
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Philipp Wolkwitz
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Gerhard Schön
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Sönke Siefert
- Catholic Children’s Hospital WilhelmstiftHamburgGermanyCatholic Children’s Hospital Wilhelmstift, Hamburg, Germany
| | - Silke Pawils
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
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Filicko A, Huennekens K, Davis K, Dolan BM, Williams BR, Feinglass J, Grobman WA, Kominiarek MA, Yee LM. Primary Care Clinician Perspectives on Patient Navigation to Improve Postpartum Care for Patients with Low Income. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:1006-1015. [PMID: 36636317 PMCID: PMC9811840 DOI: 10.1089/whr.2022.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/23/2022]
Abstract
Background Birthing individuals experience significant physical and psychosocial transitions during the postpartum period. Despite amplified health needs, many individuals do not successfully transition from obstetric to primary care. Patient navigation provides a patient-centered solution that has been applied to other health care specialties resulting in improved care coordination and patient engagement for populations in greatest need. Our objective was to understand primary care clinician perspectives regarding the role of navigators in improving postpartum care for individuals with low income. Methods In this qualitative investigation, we conducted focus groups with primary care clinicians from family and internal medicine specialties. Semistructured interview guides addressed clinician perceptions of navigator roles during the postpartum period and recommendations for navigator training. Focus group discussions were digitally recorded, transcribed, and analyzed via a constant comparative method. Results Twenty-eight primary care clinicians, including 26 physicians and 2 advanced practice registered nurses, participated in 8 focus groups. Participants reported favorable attitudes toward implementation of a postpartum patient navigation program. Themes regarding useful navigation services included streamlining obstetric to primary care transition, enhancing visit effectiveness, creating personalized postpartum care, and providing patient- and clinician-focused education. Recommendations for navigator training included education on basic medical concerns that are common in the postpartum period, health information privacy and electronic health record use, health care systems, and community resources. Clinical Trial Registration number: NCT03922334. Conclusions Primary care clinicians were highly receptive to the concept of patient navigation as a process to improve health in the postpartum period through enhanced care coordination and improved patient knowledge, engagement, and self-efficacy.
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Affiliation(s)
- Abigail Filicko
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kaitlin Huennekens
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Family Medicine, Swedish First Hill, Seattle, Washington, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brigid M. Dolan
- Division of General Internal Medicine and Geriatrics, Department of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney R. Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Address correspondence to: Lynn M. Yee, MD, MPH, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, #5-2175, Chicago, IL 60611, USA.
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Vu M, Besera G, Ta D, Escoffery C, Kandula NR, Srivanjarean Y, Burks AJ, Dimacali D, Rizal P, Alay P, Htun C, Hall KS. System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers' perspectives. Front Glob Womens Health 2022; 3:1048700. [PMID: 36589147 PMCID: PMC9794861 DOI: 10.3389/fgwh.2022.1048700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Correspondence: Milkie Vu
| | - Ghenet Besera
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Danny Ta
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Namratha R. Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Amanda J. Burks
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Emory University Physician Assistant Program, School of Medicine, Emory University, Atlanta, GA, United States
| | - Danielle Dimacali
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Pabitra Rizal
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Puspa Alay
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Cho Htun
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Kelli S. Hall
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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Yee LM, Shah SK, Grobman WA, Labellarte PZ, Barrera L, Jhaveri R. Identifying barriers and facilitators of the inclusion of pregnant individuals in hepatitis C treatment programs in the United States. PLoS One 2022; 17:e0277987. [PMID: 36399489 PMCID: PMC9674123 DOI: 10.1371/journal.pone.0277987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The rising prevalence of hepatitis C virus (HCV) infection and the availability of direct acting antivirals for HCV treatment has prompted a public health goal of HCV eradication. Despite the availability of treatment for HCV, treatment programs have generally excluded pregnant individuals. Our objective was to query patients and clinicians to identify barriers to including pregnant individuals in HCV treatment programs. METHODS AND FINDINGS This qualitative investigation included obstetricians and previously/currently pregnant individuals with HCV. Participants completed interviews regarding knowledge of and attitudes towards HCV treatment and perceived barriers to treatment during pregnancy. Data were analyzed using the constant comparative method. Obstetricians (N = 18) and patients (N = 21) described concerns about equity, access, and cost. Both expressed uncertainty about safety and confirmed a need for clinician education. Obstetricians emphasized the lack of professional guidelines. Although some clinicians expressed concern about patient adherence and engagement, patients were largely desirous of treatment; both groups identified potential benefits of antenatal treatment. CONCLUSIONS Both patients and obstetricians were generally receptive to HCV treatment in pregnancy and recognized pregnancy as an important window of opportunity for treatment. Our findings suggest the need for further research on maternal-fetal safety of HCV treatment as well as on interventions to ensure fair and appropriate access to HCV treatment for pregnant individuals.
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Affiliation(s)
- Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Seema K. Shah
- Division of Advanced General Pediatrics, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Smith Child Health Outcomes Research and Evaluation Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus, Ohio, United States of America
| | - Patricia Z. Labellarte
- Smith Child Health Outcomes Research and Evaluation Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - Leonardo Barrera
- Smith Child Health Outcomes Research and Evaluation Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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25
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Caballero TM, Miramontes-Valdes E, Polk S. Mi Plan: Using a Pediatric-Based Community Health Worker Model to Facilitate Obtainment of Contraceptives Among Latino Immigrant Parents with Contraceptive Needs. Jt Comm J Qual Patient Saf 2022; 48:591-598. [PMID: 36100556 DOI: 10.1016/j.jcjq.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bilingual community health workers (CHWs) play an important role in helping Latino immigrants with limited English proficiency (LEP) access health care services and information. Contraceptive health care services and Spanish-language contraceptive information are particularly challenging to access for uninsured LEP immigrants. Contraceptive and reproductive care are longitudinal health needs, and pediatric settings pose a unique opportunity to address these needs among parents whose children access pediatric care. The purpose of this study was to pilot the feasibility of a CHW to support parental contraceptives needs within a pediatric setting serving a high number of Latino immigrant families. This article describes Mi Plan/My Plan, a CHW contraceptive counseling and resource navigation pilot program. METHODS The research team conducted a retrospective analysis of demographic and contraceptive use data from a 15-month CHW pilot within an urban, primary care pediatrics clinic. The CHW provided contraceptive counseling, referral, and appointment coordination. The outcome was desired contraceptive method obtainment within three months of counseling. RESULTS All 311 individuals counseled were Latina mothers with median child age of 3 months. At baseline, 64.3% were using contraception and 76.5% desired to start or change their current method. Among those who desired a change, 47.9% (114/238) obtained their desired method within three months of initial counselor contact. CONCLUSION Bilingual CHW contraceptive counseling and care coordination is feasible and acceptable in a pediatric setting serving a high number of Latino immigrant families. CHWs in pediatric settings support health care access equity and are relevant to optimal maternal and child health.
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26
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Shahawy S, Onwuzurike C, Premkumar A, Henricks AA, Simon MA. Perspectives of women of refugee background on healthcare needs in a major urban metropolitan community in the US: A qualitative needs assessment. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5637-e5646. [PMID: 36111793 DOI: 10.1111/hsc.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 06/02/2023]
Abstract
The objective of this study was to describe the healthcare needs and experiences of women of refugee background in Chicago-home to one of the largest and most diverse refugee populations in the United States. We used a phenomenological study design with a desire-centered rather than damage-centered approach to conduct a series of focus group discussions with 24 women of refugee background in their native languages in Chicago, Illinois between December 2018 and February 2019. Convenience sampling was used to recruit women of refugee background at least 18 years of age living in the Chicago metropolitan area who attended educational women's health workshops at local refugee community centers. An inductive approach to the analysis was used to code transcripts and generate themes. Our study identified four major healthcare priorities for women of refugee background in a major metropolitan area: (1) central and centralised healthcare, (2) continuity of care, (3) trauma-informed care and (4) community engagement and partnerships. The healthcare priorities identified by the participants in this study should inform existing and future healthcare models and clinics providing care for women of refugee background in urban and sub-urban contexts across the United States.
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Affiliation(s)
- Sarrah Shahawy
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
- Department of Anthropology, The Graduate School, Northwestern University, Evanston, Illinois, USA
| | - Andrea A Henricks
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics & Gynecology, University of North Carolina, Raleigh, North Carolina, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine (IPHAM) - Center for Health Equity Transformation, Chicago, Illinois, USA
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27
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Mistry SK, Harris E, Harris MF. Scoping the needs, roles and implementation of bilingual community navigators in general practice settings. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5495-e5505. [PMID: 36004646 DOI: 10.1111/hsc.13973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system.
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Griese L, Finbråten HS, Francisco R, De Gani SM, Griebler R, Guttersrud Ø, Jaks R, Le C, Link T, Silva da Costa A, Telo de Arriaga M, Touzani R, Vrdelja M, Pelikan JM, Schaeffer D. HLS 19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13863. [PMID: 36360755 PMCID: PMC9654211 DOI: 10.3390/ijerph192113863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.
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Affiliation(s)
- Lennert Griese
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Hanne S. Finbråten
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
| | - Rita Francisco
- Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Saskia M. De Gani
- Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland
- Careum School of Health, Kalaidos University of Applied Sciences, 8006 Zurich, Switzerland
| | - Robert Griebler
- Competence Centre for Health Promotion and Health System, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Øystein Guttersrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Rebecca Jaks
- Careum Foundation, Careum Center for Health Literacy, 8032 Zurich, Switzerland
| | - Christopher Le
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway
- Department of Social Determinants of Health, Division of Prevention and Public Health, Norwegian Directorate of Health, 0213 Oslo, Norway
| | - Thomas Link
- Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Andreia Silva da Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1049-005 Lisboa, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal
| | - Miguel Telo de Arriaga
- Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
- Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Rajae Touzani
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue 2019, 13009 Marseille, France
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Mitja Vrdelja
- Communication Unit, National Institute of Public Health, 1000 Ljubljana, Slovenia
| | - Jürgen M. Pelikan
- WHO-CC Health Promotion in Hospitals and Health Care, Austrian National Public Health Institute, A-1010 Vienna, Austria
| | - Doris Schaeffer
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
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Wilkinson TA, Hawryluk B, Moore C, Peipert JF, Carroll AE, Wiehe S, Fortenberry JD. Developing a Youth Contraception Navigator Program: A Human-Centered Design Approach. J Adolesc Health 2022; 71:217-225. [PMID: 35562301 PMCID: PMC9329236 DOI: 10.1016/j.jadohealth.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine key elements of a contraception navigator program that provides a personalized approach to overcoming patient-specific barriers by a trained navigator in central Indiana. METHODS A human-centered design approach was used to engage adolescents and community stakeholders in co-design sessions. Sessions incorporated techniques, such as divergent brainwriting and journey maps, which led to the exploration of various themes that were ultimately used to inform key elements of the contraception navigator program. RESULTS Adolescents aged 15-17 years (N = 35) and community stakeholders (N = 11) participated in co-design sessions. Analysis verified that the process of obtaining contraception for pregnancy prevention could be intimidating for young people. The importance of language, the presence of stigma, and the knowledge of side effects were all discussed. Essential elements of a contraceptive navigator program included building trust to ultimately co-create a plan that can overcome patient-specific barriers. Having a variety of communication methods available, as well as contraceptive side-effect support, will be essential. DISCUSSION Using human-centered design techniques to engage adolescent and community stakeholders can help inform the development of a contraceptive navigator program. A trusted navigator that can address patient-specific barriers to contraception access both before and after contraception is obtained is a key element identified by stakeholders.
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Affiliation(s)
- Tracey A. Wilkinson
- Indiana University School of Medicine, Department of Pediatrics/Children’s Health Services Research, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - Bridget Hawryluk
- Indiana Clinical Translational Institute, Research Jam, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - Courtney Moore
- Indiana Clinical Translational Institute, Research Jam, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - Jeffrey F. Peipert
- Indiana University School of Medicine, Department of Obstetrics and Gynecology, UH 2440, Indianapolis, IN. 46202
| | - Aaron E. Carroll
- Indiana University School of Medicine, Department of Pediatrics/Center for Pediatric and Adolescent Comparative and Effective Research, 410 West 10th Street, HS 2000A, Indianapolis, IN. 46202
| | - Sarah Wiehe
- Indiana University School of Medicine, Department of Pediatrics/Children’s Health Services Research, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - J. Dennis Fortenberry
- Indiana University School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, 410 West 10th Street, HS 1000, Indianapolis, IN. 46202
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Dauria EF, Kulkarni P, Clemenzi-Allen A, Brinkley-Rubinstein L, Beckwith CG. Interventions Designed to Improve HIV Continuum of Care Outcomes for Persons with HIV in Contact with the Carceral System in the USA. Curr HIV/AIDS Rep 2022; 19:281-291. [PMID: 35674879 PMCID: PMC9175158 DOI: 10.1007/s11904-022-00609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe existing evidence and identify future directions for intervention research related to improving HIV care outcomes for persons with HIV involved in the carceral system in the USA, a population with high unmet HIV care needs. RECENT FINDINGS Few recent intervention studies focus on improving HIV care outcomes for this population. Successful strategies to improve care outcomes include patient navigation, substance use treatment, and incentivizing HIV care outcomes. Technology-supported interventions are underutilized in this population. Notable gaps in the existing literature include intervention research addressing HIV care needs for cisgender and transgender women and those under carceral supervision in the community. Future research should address existing gaps in the literature and respond to emergent needs including understanding how the changing HIV care delivery environment resulting from the COVID-19 pandemic and the approval of new injectable ART formulation shape HIV care outcomes in this population.
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Affiliation(s)
- Emily F Dauria
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Priyanka Kulkarni
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine and Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Curt G Beckwith
- Alpert Medical School, Division of Infectious Diseases/Department of Medicine, Brown University, Providence, RI, USA
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31
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Martinez NG, Yee LM, Miller ES. Is Postpartum Patient Navigation Uniquely Beneficial for Women with Antenatal Depressive Symptoms? Am J Perinatol 2022; 39:1189-1195. [PMID: 33321528 DOI: 10.1055/s-0040-1721696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Women with depression benefit substantively from the comprehensive postpartum visit yet are less likely to attend such visits. Postpartum patient navigation has been associated with improved postpartum visit attendance. Thus, the objective of this study was to determine whether patient navigation was associated with differential postpartum visit attendance for low-income, largely racial/ethnic minority women with antenatal depressive symptoms. STUDY DESIGN This is a secondary analysis of a prospective postpartum patient navigation program for adult, low-income, largely racial/ethnic minority women receiving prenatal care at a single university clinic (n = 474). Patient navigators assumed supportive and logistical responsibilities for patients between delivery and postpartum visit completion ("navigation cohort"); women in the navigation cohort were compared with women who would have been eligible for patient navigation but received care the year before program implementation ("pre-navigation cohort"). Women were considered to have antenatal depressive symptoms if they had a Patient Health Questionnaire-9 score above 9 prior to delivery. The primary outcome was attendance at the comprehensive postpartum visit by 12 weeks. Factors associated with this outcome were assessed in a prenavigation cohort of women and were subsequently evaluated in the total cohort (prenavigation and navigation groups) using multivariable models. An interaction term between antenatal depressive symptoms and navigation status was generated to evaluate for effect modification. RESULTS In the prenavigation cohort, antenatal depressive symptoms were more frequent among women who did not attend the postpartum visit (25.0 vs. 10.2%, p = 0.002) and remained a risk factor for postpartum visit nonattendance on multivariable analysis (adjusted odds ratio [aOR]: 0.39, 95% confidence interval [CI]: 0.18-0.83). In the navigation cohort (n = 218), the presence of antenatal depressive symptoms was not associated with attendance (p = 0.117). In multivariable analyses of the total cohort, the interaction term between antenatal depressive symptoms and navigation was statistically significant (aOR: 11.06, 95% CI: 1.21-101.08). CONCLUSION Postpartum patient navigation appears particularly beneficial among women with antenatal depressive symptoms for increasing postpartum appointment attendance. KEY POINTS · Patient navigation has been associated with improved postpartum visit attendance.. · Among low-income women, antenatal depressive symptoms are a risk factor for postpartum visit nonattendance.. · Postpartum patient navigation appears particularly beneficial among women with antenatal depressive symptoms..
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Affiliation(s)
- Noelle G Martinez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Liu M, Simione M, Perkins ME, Price SN, Luo M, Lopez W, Catalan VM, Chen SYT, Torres C, Kwete GM, Seigel M, Edlow AG, Parra MY, Hunter ML, Boudreau AA, Taveras EM. Implementation Evaluation of HUGS/Abrazos During the COVID-19 Pandemic: A Program to Foster Resiliency in Pregnancy and Early Childhood. Front Public Health 2022; 10:862388. [PMID: 35669744 PMCID: PMC9163339 DOI: 10.3389/fpubh.2022.862388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/22/2022] [Indexed: 11/21/2022] Open
Abstract
Early life adversity can significantly impact child development and health outcomes throughout the life course. With the COVID-19 pandemic exacerbating preexisting and introducing new sources of toxic stress, social programs that foster resilience are more necessary now than ever. The Helping Us Grow Stronger (HUGS/Abrazos) program fills a crucial need for protective buffers during the COVID-19 pandemic, which has escalated toxic stressors affecting pregnant women and families with young children. HUGS/Abrazos combines patient navigation, behavioral health support, and innovative tools to ameliorate these heightened toxic stressors. We used a mixed-methods approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to evaluate the implementation of the HUGS/Abrazos program at Massachusetts General Hospital from 6/30/2020-8/31/2021. Results of the quality improvement evaluation revealed that the program was widely adopted across the hospital and 392 unique families were referred to the program. The referred patients were representative of the communities in Massachusetts disproportionately affected by the COVID-19 pandemic. Furthermore, 79% of referred patients followed up with the initial referral, with sustained high participation rates throughout the program course; and they were provided with an average of four community resource referrals. Adoption and implementation of the key components in HUGS/Abrazos were found to be appropriate and acceptable. Furthermore, the implemented program remained consistent to the original design. Overall, HUGS/Abrazos was well adopted as an emergency relief program with strong post-COVID-19 applicability to ameliorate continuing toxic stressors while decreasing burden on the health system.
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Affiliation(s)
- Meisui Liu
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Meg Simione
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Meghan E. Perkins
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Sarah N. Price
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Mandy Luo
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - William Lopez
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Viktoria M. Catalan
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Szu-Yu Tina Chen
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Carlos Torres
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- MGH Chelsea HealthCare Center, Chelsea, MA, United States
| | - Gracia M. Kwete
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- MGH Revere HealthCare Center, Revere, MA, United States
| | - Molly Seigel
- Harvard Medical School, Boston, MA, United States
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Andrea G. Edlow
- Harvard Medical School, Boston, MA, United States
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Alexy Arauz Boudreau
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- MGH Chelsea HealthCare Center, Chelsea, MA, United States
| | - Elsie M. Taveras
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Greenberg MB, Gandhi M, Davidson C, Carter EB. Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery-Addressing systemic racism and other social determinants of health as causes of obstetrical disparities. Am J Obstet Gynecol 2022; 227:B44-B59. [PMID: 35378098 DOI: 10.1016/j.ajog.2022.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Centers for Disease Control and Prevention define social determinants of health as "the conditions in the places where people live, learn, work, and play" that can affect health outcomes. Systemic racism is a root cause of the power and wealth imbalances that affect social determinants of health, creating disproportionate rates of comorbidities and adverse outcomes in the communities of racial and ethnic minority groups. Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.
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Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010-2019. Obstet Gynecol 2022; 139:172-180. [PMID: 34991132 PMCID: PMC8849543 DOI: 10.1097/aog.0000000000004649] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of pregnancy-associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019. METHODS Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification of Diseases, Tenth Revision codes, calculated pregnancy-associated death ratios, and categorized deaths by cause, timing relative to pregnancy, race or ethnicity, and age. RESULTS Of 11,782 pregnancy-associated deaths identified between 2010 and 2019, 11.4% were due to drugs, 5.4% were due to suicide, and 5.4% were due to homicide, whereas 59.3% were due to obstetric causes and the remaining 18.5% were due to other causes. Drug-related deaths, suicide, and homicide accounted for 22.2% of pregnancy-associated deaths. All three causes of death increased over the study period, with drug-related pregnancy-associated deaths increasing 190%. Homicide during pregnancy and drug-related deaths, suicides, and homicide in the late postpartum period (43-365 days) accounted for a larger proportion of all deaths in these time periods than the contribution of these causes to all deaths among females of reproductive age. Pregnant and postpartum people identified as non-Hispanic American Indian or Alaska Native were at highest risk of drug-related and suicide death, and people identified as non-Hispanic Black were at highest risk of homicide. CONCLUSION Deaths due to drug use, suicide, and homicide constitute more than one fifth of all deaths during pregnancy and the first year postpartum. Drug-related deaths and homicides have increased over the past decade. Substantial racial and ethnic inequities in these deaths exist.
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Gorman JR, Drizin JH, Smith E, Flores-Sanchez Y, Harvey SM. Patient-Centered Communication to Address Young Adult Breast Cancer Survivors' Reproductive and Sexual Health Concerns. HEALTH COMMUNICATION 2021; 36:1743-1758. [PMID: 32703034 DOI: 10.1080/10410236.2020.1794550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Women faced with a diagnosis of breast cancer as young adults commonly experience negative effects of cancer and cancer treatment on their reproductive and sexual health (RSH) that are inadequately addressed by their healthcare providers (HCPs). The objectives of this study were to 1) identify approaches to improving RSH communication from YA breast cancer survivors' perspectives, 2) identify facilitators and barriers to the approaches identified, and 3) identify specific strategies to improve patient-centered RSH communication. We conducted individual telephone interviews with 29 women who were diagnosed with breast cancer under age 40 years. We used a grounded theory approach to identify themes, and explored how the themes related to the PCC framework to elucidate specific strategies for improving communication. Three main themes emerged: 1) Normalizing and integrating assessment of RSH concerns; 2) HCP conveying genuine caring and investment; and 3) Improving accessibility of comprehensive RSH services after cancer. Results revealed concrete strategies for improving patient-centered RSH communication at the patient-provider and health system levels. These included reminding patients that RSH concerns are common, routinely asking about RSH, using active listening, and connecting patients to HCP who can address their RSH concerns.
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Affiliation(s)
- Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | - Julia H Drizin
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | - Ellie Smith
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
| | | | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, 97331, OR, USA
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Morris MH, Barton M, Zane M, Hutson SP, Raman R, Heidel RE. A Nurse-Navigated, Postpartum Support Text Messaging Intervention: Satisfaction Among Primiparous Women. J Perinat Neonatal Nurs 2021; 35:330-339. [PMID: 34726650 PMCID: PMC8567297 DOI: 10.1097/jpn.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than 50% of maternal deaths in the United States occur during the first year following childbirth. Nearly 40% of these deaths occur between days 1 and 41 of the postpartum period. Historically, women receive less attention from healthcare providers during the postpartum period when compared with the care provided during pregnancy and childbirth. Women may not return for scheduled follow-up care until 4 to 6 weeks after birth, if they return at all. The role of postpartum nurse navigator (PPNN) was developed to deliver a novel, text messaging intervention as part of a randomized controlled trial to 43 primiparous women who experienced an unplanned cesarean birth. Through daily, interactive text messaging, the PPNN assessed study participants' general well-being, assisted with symptom navigation, offered anticipatory guidance, and provided informational support until 4 weeks postpartum. Satisfaction with the intervention was evaluated using a survey that incorporated quantitative and qualitative responses. Overwhelmingly, 93% of participants rated their overall experience with the text messaging intervention as outstanding or good. At least 95% of the participants indicated that they would likely choose to receive daily text messaging from a PPNN following a subsequent birth. Convenient access to professional nurse support for women postbirth warrants further evaluation.
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Affiliation(s)
- Melanie Hall Morris
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, Tennessee (Dr Morris and Ms Barton); TriStar Summit Medical Center, Hermitage, Tennessee (Ms Zane); College of Nursing, The University of Tennessee, Knoxville (Dr Hutson); Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Raman); and Office of Biostatistics & Research Consultation, University of Tennessee Graduate School of Medicine, Knoxville (Dr Heidel)
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Yee LM, Williams B, Green HM, Carmona-Barrera V, Diaz L, Davis K, Kominiarek MA, Feinglass J, Zera CA, Grobman WA. Bridging the postpartum gap: best practices for training of obstetrical patient navigators. Am J Obstet Gynecol 2021; 225:138-152. [PMID: 33812809 PMCID: PMC8328879 DOI: 10.1016/j.ajog.2021.03.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/02/2023]
Abstract
The postpartum period represents a critical window of opportunity to improve maternal short- and long-term health, including optimizing postpartum recovery, providing effective contraception, caring for mood disorders, managing weight, supporting lactation, initiating preventive care, and promoting cardiometabolic health. However, inadequate postpartum care, especially for individuals facing social and structural barriers, is common in the United States and contributes to suboptimal health outcomes with lasting consequences. Patient navigation is a patient-centered intervention that uses trained personnel to identify financial, cultural, logistical, and educational obstacles to effective healthcare and to mitigate these barriers to facilitate comprehensive and timely access to needed health services. Given the emerging evidence suggesting that patient navigation may be a promising method to improve health among postpartum individuals, our team developed a postpartum patient navigator training guide to be used in the Navigating New Motherhood 2 and other obstetrical navigation programs. Navigating New Motherhood 2 is a randomized trial exploring whether patient navigation by a trained, lay postpartum navigator for individuals with a low income can improve health and patient-reported outcomes during and after the postpartum period. Hiring and training patient navigators without health professional degrees are integral components of initiating a navigation program. However, patient navigator training is highly variable, and no guideline regarding key elements in such a training program exists for obstetrics specifically. Thus, this paper aimed to describe the core principles, content, and rationale for each element in a comprehensive postpartum patient navigator training program. Training should be centered around the following 6 core elements: (1) principles of patient navigation; (2) knowledge of pregnancy and postpartum care; (3) health education and health promotion principles; (4) cultural sensitivity and health equity; (5) care coordination and community resources; and (6) electronic medical record systems. These core elements can serve as a basis for the development of adaptable curricula for several institutions and contexts. In addition, we offer recommendations for the implementation of a navigator training program. A curriculum with built-in flexibility to meet community and institutional needs may promote the effective and sustainable use of patient navigation in the postpartum context.
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Affiliation(s)
- Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chloe A Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Ruderman RS, Dahl EC, Williams BR, Davis K, Feinglass JM, Grobman WA, Kominiarek MA, Yee LM. Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals. ACTA ACUST UNITED AC 2021; 2:254-262. [PMID: 34318295 PMCID: PMC8310741 DOI: 10.1089/whr.2021.0009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Background: Recent paradigm shifts in postpartum care have conceptualized the “fourth trimester” as a critical transitional period requiring tailored, ongoing health care. However, this concept presents challenges for providers, especially in low-resource settings. Our objective was to understand providers' perspectives on challenges in postpartum care to highlight strategies for optimizing care. Methods: Focus groups were conducted using a semistructured interview guide to elicit perspectives on barriers and facilitators to postpartum care. Participants included physicians, nurses, and social workers who care for low-income postpartum individuals. Interviews explored the provider experience of postpartum care, with a focus on barriers experienced by patients and providers, and tools for maintaining engagement. Analysis was performed using the constant comparative method and framed by the Social Ecological Model. Results: Participants (N = 26) all acknowledged the importance of the “fourth trimester” but identified multiple barriers to providing optimal postpartum care. Challenges providers perceived for patients and those they perceived for themselves often overlapped, including difficulty with appointment scheduling, insurance limitations, lack of provider continuity, and knowledge gaps. Providers identified ease of referrals to specialists, access to tangible services (e.g., contraception), and enhanced care coordination (e.g., patient navigation) as potential facilitators of improved postpartum care. Conclusions: Obstetric providers recognize the importance of postpartum care yet highlighted significant systems- and patient-based barriers to achieving optimal care. The development and implementation of postpartum care delivery system redesign, such as the use of patient navigators to improve health care utilization and resource attainment, may enhance care during this critical time. Clinical Trial No.: NCT03922334.
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Affiliation(s)
- Rachel S Ruderman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma C Dahl
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney R Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe M Feinglass
- Division of General Internal Medicine and Geriatrics, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Rawlings D, Litster C, Miller-Lewis L, Tieman J, Swetenham K. End-of-life doulas: A qualitative analysis of interviews with Australian and International death doulas on their role. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:574-587. [PMID: 32748426 DOI: 10.1111/hsc.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/21/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Death doulas (DD) are working with people at the end of life in varied roles with more clarity needed around their role and place within the health and social care systems. The aim of this work is to explore the DD role in end-of-life care from the perspective of DDs. A sub-group of 20 DDs from a larger quantitative survey participated in semi-structured telephone Skype or Zoom interviews. Interview data were analysed using thematic analysis. Seven themes emerged from the qualitative analysis: what a DD offers, what a DD does, challenges and barriers, occupational preferences, family support, contract of service/fee and regulation. There is a general perception that healthcare professionals (HCP) do not understand what it is that DDs do; thus, the current study has helped to demystify the DD role and potentially reduce suspicion. The lack of a DD business model sees inconsistencies in what services each DD offers and what patients and families can expect. End of life is complex and confusing for patients and families and there is a need to further explore the DD role and how it can work when there are many inconsistencies in working practice. More research is required to look at the interplay among DDs, HCPs and palliative care volunteers in addressing the gaps in care provision and how these relationships might be more seamlessly managed.
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Affiliation(s)
- Deb Rawlings
- Palliative & Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Caroline Litster
- Palliative & Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Lauren Miller-Lewis
- Palliative & Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Jennifer Tieman
- Palliative & Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Kate Swetenham
- Southern Adelaide Palliative Services, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
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Hu F, Strohbach A, Martinez NG, Simon MA, Yee LM. Patient and Provider Perceptions of a Patient Navigation Program to Improve Postpartum Care Among Publicly Insured Women. Am J Perinatol 2021; 38:248-257. [PMID: 31491803 PMCID: PMC9472559 DOI: 10.1055/s-0039-1696671] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study was aimed to assess patient and provider perceptions of a postpartum patient navigation program. STUDY DESIGN This was a mixed-method assessment of a postpartum patient navigation program. Navigating New Motherhood (NNM) participants completed a follow-up survey including the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale and an open-ended question. PSN-I scores were analyzed descriptively. Eighteen provider stakeholders underwent in-depth interviews to gauge program satisfaction, perceived outcomes, and ideas for improvement. Qualitative data were analyzed by the constant comparative method. RESULTS In this population of low-income, minority women, participants (n = 166) were highly satisfied with NNM. The median PSN-I score was 45 out of 45 (interquartile range [IQR]: 43-45), where a higher score corresponds to higher satisfaction. Patient feedback was also highly positive, though a small number desired more navigator support. Provider stakeholders offered consistently positive program feedback, expressing satisfaction with NNM execution and outcomes. Provider stakeholders noted that navigators avoided inhibiting clinic workflow and eased clinic administrative burden. They perceived NNM improved multiple clinical and satisfaction outcomes. All provider stakeholders believed that NNM should be sustained long-term; suggestions for improvement were offered. CONCLUSION A postpartum patient navigation program can perceivably improve patient satisfaction, clinical care, and clinic workflow without burden to clinic providers.
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Affiliation(s)
- Fengling Hu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angelina Strohbach
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Noelle G. Martinez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa A. Simon
- Departments of Obstetrics and Gynecology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Stark EL, Miller ES. Diabesity and Perinatal Mental Health: Evidence-based Recommendations for Screening and Intervention. Clin Obstet Gynecol 2020; 64:204-213. [PMID: 33284142 DOI: 10.1097/grf.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perinatal mental illness, obesity, and diabetes mellitus are common complications of the perinatal period that are becoming ever more prevalent and frequently co-occur. This review seeks to examine the prevalence of comorbid obesity/diabetes (termed "diabesity") and mental illness in the perinatal period and current understandings of the psychosocial and pathophysiological relationships between these diseases. We will present current guidelines for screening and make recommendations for adaptations of mental health treatment in patients with this comorbidity. Finally, we present future directions for research and clinical intervention.
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Affiliation(s)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Dessources K, Hari A, Pineda E, Amneus MW, Sinno AK, Holschneider CH. Socially determined cervical cancer care navigation: An effective step toward health care equity and care optimization. Cancer 2020; 126:5060-5068. [DOI: 10.1002/cncr.33124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly Dessources
- Department of Surgery Memorial Sloan Kettering Cancer Center New York New York
| | - Anjali Hari
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Elizabeth Pineda
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Malaika W. Amneus
- Department of Obstetrics and Gynecology Kaiser Permanente Panorama City Panorama City California
| | - Abdulrahman K. Sinno
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Christine H. Holschneider
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
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Griese L, Berens EM, Nowak P, Pelikan JM, Schaeffer D. Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5731. [PMID: 32784395 PMCID: PMC7460304 DOI: 10.3390/ijerph17165731] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
Due to their rapid expansion and complexity, it is increasingly difficult for patients to orient themselves in health care systems. Therefore, patients require a high degree of health literacy, or more precisely, navigation health literacy (HL-NAV). The actual extent of HL-NAV of patients and citizens is still largely unknown due to the lack of adequate measurement instruments. Thus, within the new international Health Literacy Population Survey 2019 (HLS19), one aim was to develop a suitable instrument for measuring HL-NAV in the HLS19 the HL-NAV-HLS19. The item development was conducted by an international working group within the HLS19 Consortium led by the first and last authors. Methodologically, it is based on a scoping literature review, development of a conceptual framework for HL-NAV, and first item formation, as well as an evaluation by experts, stakeholders, focus groups, pre-test interviews, and continuously feedback from the HLS19 Consortium. HL-NAV was defined as the ability to access, understand, appraise, and apply information on navigational issues, drawing on ten selected publications and the health literacy definition of the HLS-EU Consortium. Main tasks of HL-NAV at the system, organization, and interaction level were identified, to which first related items were assigned. Based on the feedback from experts, the focus group discussions, and the HLS19 Consortium, the instrument was slightly revised. Finally, twelve items proved to be feasible in the pre-test. The instrument will be used for the first time in the HLS19 survey and will provide first data on HL-NAV in general populations for the countries participating in HLS19. It is suited for cross-country comparisons and monitoring, as well as for intervention development. However, the instrument should be translated into and validated in further languages and countries for population samples.
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Affiliation(s)
- Lennert Griese
- School of Public Health, Interdisciplinary Centre for Health Literacy Research [ICHL], Bielefeld University, 33615 Bielefeld, Germany; (E.-M.B.); (D.S.)
| | - Eva-Maria Berens
- School of Public Health, Interdisciplinary Centre for Health Literacy Research [ICHL], Bielefeld University, 33615 Bielefeld, Germany; (E.-M.B.); (D.S.)
| | - Peter Nowak
- Department Health and Society, The Austrian Public Health Institute [GÖG], 1010 Vienna, Austria;
| | - Jürgen M. Pelikan
- WHO-CC Health Promotion in Hospitals and Health Care, The Austrian Public Health Institute [GÖG], 1010 Vienna, Austria;
| | - Doris Schaeffer
- School of Public Health, Interdisciplinary Centre for Health Literacy Research [ICHL], Bielefeld University, 33615 Bielefeld, Germany; (E.-M.B.); (D.S.)
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Simon MA, Trosman JR, Rapkin B, Rittner SS, Adetoro E, Kirschner MC, O'Brian CA, Tom LS, Weldon CB. Systematic Patient Navigation Strategies to Scale Breast Cancer Disparity Reduction by Improved Cancer Prevention and Care Delivery Processes. JCO Oncol Pract 2020; 16:e1462-e1470. [PMID: 32574137 DOI: 10.1200/jop.19.00314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient navigation uses trained personnel to eliminate barriers to timely care across all phases of the health care continuum, thereby reducing health disparities. However, patient navigation has yet to be systematized in implementation models to improve processes of care at scale rather than remain a band-aid approach focused solely on improving care for the individual patient. The 4R systems engineering approach (right information and right treatment to the right patient at the right time) uses project management discipline principles to develop care sequence templates that serve as patient-centered project plans guiding patients and their care team. METHODS A case-study approach focused on the underserved patient shows how facilitators to timely breast cancer screening and care pragmatically identified as emergent data by patient navigators can be actionized by iteratively revising 4R care sequence templates to incorporate new insights as they emerge. RESULTS Using a case study of breast cancer screening of a low-income patient, we illustrate how 4R care sequence templates can be revised to incorporate emergent facilitators to care identified through patient navigation. CONCLUSION Use of care sequence templates can inform the care team to optimize a particular patient's care, while functioning as a learning health care system for process improvement of patient care and patient navigation scaling. A learning health care system approach that systematically integrates data patterns emerging from multiple patient navigation experiences through in-person navigators and 4R care sequence templates may improve processes of care and allow patient navigation scaling to reduce cancer disparities.
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Affiliation(s)
- Melissa A Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julia R Trosman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Center for Business Models in Healthcare, Glencoe, IL
| | - Bruce Rapkin
- Division of Community Collaboration & Implementation Sciences, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Sarah S Rittner
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Marcie C Kirschner
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine A O'Brian
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura S Tom
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christine B Weldon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Center for Business Models in Healthcare, Glencoe, IL
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Sawangkum P, Louis JM. Gestational Weight Gain: Achieving a Healthier Weight Between Pregnancies. Obstet Gynecol Clin North Am 2020; 47:397-407. [PMID: 32762925 DOI: 10.1016/j.ogc.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rates of obesity continue to be a cause of morbidity and mortality, requiring intervention. Excessive gestational weight gain is related to postpartum weight retention and subsequent development of obesity, which translates into higher risk of adverse maternal and neonatal outcomes in future pregnancies and long-term excess cardiovascular disease and cancer for the mothers. Limiting gestational weight gain to within recommended limits prevents postpartum weight retention. This article provides an overview of methods and practices aimed at helping women achieve a healthy weight between pregnancies by improving gestational weight gain. These interventions include lifestyle behavioral changes, diet and exercise, and motivational interviewing.
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Affiliation(s)
- Peeraya Sawangkum
- Department of Obstetrics and Gynecology, University of South Florida, 6th Floor, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, University of South Florida, 6th Floor, 2 Tampa General Circle, Tampa, FL 33606, USA.
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46
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Nyhof BB, Wright FC, Look Hong NJ, Groot G, Helyer L, Meiers P, Quan ML, Baxter NN, Urquhart R, Warburton R, Gagliardi AR. Identifying opportunities to support patient-centred care for ductal carcinoma in situ: qualitative interviews with clinicians. BMC Cancer 2020; 20:364. [PMID: 32354355 PMCID: PMC7191683 DOI: 10.1186/s12885-020-06821-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background Women with ductal carcinoma in situ (DCIS) report poor patient-clinician communication, and long-lasting confusion and anxiety about their treatment and prognosis. Research shows that patient-centred care (PCC) improves patient experience and outcomes. Little is known about the clinician experience of delivering PCC for DCIS. This study characterized communication challenges faced by clinicians, and interventions they need to improve PCC for DCIS. Methods Purposive and snowball sampling were used to recruit Canadian clinicians by specialty, gender, years of experience, setting, and geographic location. Qualitative interviews were conducted by telephone. Data were analyzed using constant comparison. Findings were mapped to a cancer-specific, comprehensive PCC framework to identify opportunities for improvement. Results Clinicians described approaches they used to address the PCC domains of fostering a healing relationship, exchanging information, and addressing emotions, but do not appear to be addressing the domains of managing uncertainty, involving women in making decisions, or enabling self-management. However, many clinicians described challenges or variable practices for all PCC domains but fostering a healing relationship. Clinicians vary in describing DCIS as cancer based on personal beliefs. When exchanging information, most find it difficult to justify treatment while assuring women of a good prognosis, and feel frustrated when women remain confused despite their efforts to explain it. While they recognize confusion and anxiety among women, clinicians said that patient navigators, social workers, support groups and high-quality information specific to DCIS are lacking. Despite these challenges, clinicians said they did not need or want communication interventions. Conclusions Findings represent currently unmet opportunities by which to help clinicians enhance PCC for DCIS, and underscore the need for supplemental information and supportive care specific to DCIS. Future research is needed to develop and test communication interventions that improve PCC for DCIS. If effective and widely implemented, this may contribute to improved care experiences and outcomes for women diagnosed with and treated for DCIS.
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Affiliation(s)
- Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.
| | | | | | - Gary Groot
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Pamela Meiers
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Nancy N Baxter
- St Michael's Hospital Department of Surgery and Li Ka Shing Knowledge Institute, Department of Surgery and the Institute for Health Policy Management and Evaluation, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
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Abstract
Patients with gynecologic cancers experience better outcomes when treated by specialists and institutions with experience in their diseases. Unfortunately, high-volume centers tend to be located in densely populated regions, leaving many women with geographic barriers to care. Remote management through telemedicine offers the possibility of decreasing these disparities by extending the reach of specialty expertise and minimizing travel burdens. Telemedicine can assist in diagnosis, treatment planning, preoperative and postoperative follow-up, administration of chemotherapy, provision of palliative care, and surveillance. Telemedical infrastructure requires careful consideration of the needs of relevant stakeholders including patients, caregivers, referring clinicians, specialists, and health system administrators.
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48
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Ponting C, Mahrer NE, Zelcer H, Schetter CD, Chavira DA. Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review. Clin Psychol Psychother 2020; 27:249-265. [PMID: 31960525 PMCID: PMC7125032 DOI: 10.1002/cpp.2424] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022]
Abstract
Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non-Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non-randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post-treatment using non-controlled designs. The remaining eight studies (seven randomized and one non-randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
| | - Nicole E. Mahrer
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
- Department of Psychology, University of La Verne, La Verne,
CA
| | - Hannah Zelcer
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
| | | | - Denise A. Chavira
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
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Broder-Fingert S, Kuhn J, Sheldrick RC, Chu A, Fortuna L, Jordan M, Rubin D, Feinberg E. Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol. Trials 2019; 20:728. [PMID: 31842963 PMCID: PMC6915979 DOI: 10.1186/s13063-019-3853-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Delivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions—and furthermore understanding the impact of each strategy on effectiveness—has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions, i.e., to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. Methods/design The MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The Preparation phase for this study occurred previously. The current study consists of the Optimization and Evaluation phases. Children aged 3-to-12 years old who are detected as “at-risk” for behavioral health disorders (n = 304) at a large, urban federally qualified community health center will be referred to a Family Partner—a bicultural, bilingual member of the community with training in behavioral health and systems navigation—who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2 × 2 × 2× 2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on the fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost. Discussion In this protocol paper, we describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation. Trial registration ClinicalTrials.gov, NCT03569449. Registered on 26 June 2018.
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Affiliation(s)
- Sarabeth Broder-Fingert
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | - Jocelyn Kuhn
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA
| | | | - Andrea Chu
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Lisa Fortuna
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA
| | | | - Dana Rubin
- Boston University School of Medicine, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
| | - Emily Feinberg
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
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50
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Chor J, Young D, Quinn MT, Gilliam M. A Novel Lay Health Worker Training to Help Women Engage in Postabortion Contraception and Well-Woman Care. Health Promot Pract 2019; 21:172-174. [DOI: 10.1177/1524839919874757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young women, low-income women, and women of color make up a disproportionate share of abortion patients and experience higher rates of unintended pregnancy, maternal morbidity and mortality, and infant mortality. Furthermore, these individuals are also less likely to have access to preventive gynecologic care. Whereas lay health worker interventions have been developed to help link individuals to care in other fields, the use of such interventions to link individuals to preventive care after abortion is novel. This article describes a training protocol and curriculum that provided nonmedically trained individuals with knowledge, skills, and competency to conduct a behavioral theory–based counseling intervention to help individuals achieve self-identified goals regarding obtaining postabortion reproductive health care and contraception. When piloted with 60 patients presenting for abortion who lacked a regular health care provider and desired to delay pregnancy for at least 6 months, participants found the lay health worker skills and the counseling session highly acceptable. Specifically, participants reported feeling comfortable speaking to lay health workers about contraception and reproductive health care. These findings indicate that lay health worker interventions may present an important opportunity to help individuals address their postabortion preventive and contraceptive health care needs.
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Affiliation(s)
- Julie Chor
- The University of Chicago, Chicago, IL, USA
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