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Cameron NA, Birdsell H, Niznik CM, Michon R, Donelan E, Yee LM, Dolan BM. An Enhanced Postpartum Transition Program to Primary Care. J Womens Health (Larchmt) 2024; 33:1417-1422. [PMID: 38634543 DOI: 10.1089/jwh.2023.0465] [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: 04/19/2024] Open
Abstract
Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are risk factors for future cardiovascular disease, yet few individuals receive postpartum care with primary care clinicians (PCP). To facilitate transitions of care to PCPs and improve cardiovascular health monitoring within the first 13 months postpartum, we developed and piloted an enhanced postpartum referral pathway for patients with GDM or HDP. Methods: Eligible patients included those who received perinatal care at a large, urban, academic medical center, experienced GDM or HDP during their most recent pregnancy, and lacked an existing PCP. Resident, faculty, and advanced practitioners referred patients during antenatal, delivery-related, or postpartum visits. A dedicated scheduler contacted patients to schedule an appointment with a women's health-focused resident or faculty PCP. The percent of patients who attended a postpartum PCP visit, who had an HbA1c and cholesterol panel checked within the first 13 months postpartum, were compared between patients referred and not referred to the program using adjusted odds ratios (aOR). Results: Of 129 individuals referred, 48.1% attended a PCP visit, 31.8% completed cholesterol screening, and 41.9% completed HbA1c screening within 13 months postpartum. After adjusting for age, parity, insurance, and referral indication, referred individuals had greater odds for each outcome (PCP visit: aOR = 6.0, 95% CI 4.0-9.0; cholesterol: aOR = 2.4, 95% 1.6-3.9; HbA1c: aOR = 2.5, 95% CI 1.7-3.7) compared with nonreferred individuals in the same time period. Discussion: A enhanced postpartum PCP referral pathway pilot for birthing individuals was associated with improved follow-up in the first year postpartum.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Heather Birdsell
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charlotte M Niznik
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ruth Michon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Dartmouth University, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brigid M Dolan
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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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; 33:975-985. [PMID: 38265478 DOI: 10.1089/jwh.2023.0459] [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: 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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Leonard SA, Girsen AI, Trepman P, Carmichael SL, Darmawan K, Butwick AJ, Gibbs RS. Early Postpartum Hospital Encounters among Patients with Genitourinary and Wound Infections during Hospitalization for Birth. Am J Perinatol 2024; 41:e2017-e2025. [PMID: 37216972 DOI: 10.1055/a-2097-1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES This study aimed to assess the associations between genitourinary and wound infections during the birth hospitalization and early postpartum hospital encounters, and to evaluate clinical risk factors for early postpartum hospital encounters among patients with genitourinary and wound infections during the birth hospitalization. STUDY DESIGN We conducted a population-based cohort study of births in California during 2016 to 2018 and postpartum hospital encounters. We identified genitourinary and wound infections using diagnosis codes. Our main outcome was early postpartum hospital encounter, defined as a readmission or emergency department (ED) visit within 3 days after discharge from the birth hospitalization. We evaluated the association of genitourinary and wound infections (overall and subtypes) with early postpartum hospital encounter using logistic regression, adjusting for sociodemographic factors and comorbidities and stratified by mode of birth. We then evaluated factors associated with early postpartum hospital encounter among patients with genitourinary and wound infections. RESULTS Among 1,217,803 birth hospitalizations, 5.5% were complicated by genitourinary and wound infections. Genitourinary or wound infection was associated with an early postpartum hospital encounter among patients with both vaginal births (2.2%; adjusted risk ratio [aRR[: 1.26; 95% confidence interval [CI]: 1.17-1.36) and cesarean births (3.2%; aRR: 1.23; 95% CI: 1.15-1.32). Patients with a cesarean birth and a major puerperal infection or wound infection had the highest risk of an early postpartum hospital encounter (6.4 and 4.3%, respectively). Among patients with genitourinary and wound infections during the birth hospitalization, factors associated with an early postpartum hospital encounter included severe maternal morbidity, major mental health condition, prolonged postpartum hospital stay, and, among cesarean births, postpartum hemorrhage (p-value < 0.05). CONCLUSION Genitourinary and wound infections during hospitalization for birth may increase risk of a readmission or ED visit within the first few days after discharge, particularly among patients who have a cesarean birth and a major puerperal infection or wound infection. KEY POINTS · In all, 5.5% of patients giving birth had a genitourinary or wound infection (GWI).. · A total of 2.7% of GWI patients had a hospital encounter within 3 days of discharge after birth.. · Major puerperal infection and wound infection had the highest risk of an early hospital encounter.. · Among GWI patients, several birth complications were associated with an early hospital encounter..
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Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Anna I Girsen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Paula Trepman
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Suzan L Carmichael
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
- Department of Pediatrics, Stanford University, Stanford, California
| | - Kelly Darmawan
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Siegel MR, Simione M, James KE, Perkins ME, Luo M, Swift H, Kim J, Jasset OJ, Shook LL, Taveras EM, Edlow AG. Helping Us Grow Stronger (HUGS)/Abrazos: a community-based initiative improved perinatal mental health in an urban cohort. Am J Obstet Gynecol MFM 2024; 6:101264. [PMID: 38135219 PMCID: PMC10922876 DOI: 10.1016/j.ajogmf.2023.101264] [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] [Received: 09/11/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Targeted programs aimed at improving maternal mental health, particularly among those exposed to social determinants of health, are increasingly critical since the onset of the COVID-19 pandemic, yet the impact of such programs is poorly understood. OBJECTIVE This study aimed to evaluate the impact of a novel, language-concordant community-based program on perinatal mental health. STUDY DESIGN We conducted a prospective cohort study of peripartum individuals referred to a new community-based intervention known as Helping Us Grow Stronger (HUGS/Abrazos). Participants received up to 4 remote sessions with a cognitive behavioral therapy trained social worker, up to 3 resource navigation sessions with a community health worker, and direct relief with a grocery gift card and care package. Before and after the program, participants completed validated survey instruments to assess mental health and social determinants of health. RESULTS A total of 178 participants were assessed after program completion, including 133 who were assessed before and after the program. The cohort was composed of 62.9% Hispanic or Latinx participants with a mean age of 29.8 year (standard error of mean, 0.46). There were high rates of food insecurity (111/178; 62.4%), experiences of discrimination (119/178; 66.9%), and SARS-CoV-2 infection (105/178; 59.0%). The program was associated with statistically significant improvements in the Edinburgh Postnatal Depression scores (baseline [mean±standard error of mean], 8.44±0.55 vs 6.77±0.51 after program completion; P=.0001) and Perceived Stress Scale scores (baseline, 15.2±0.74 vs 14.0±0.71; P=.035). Participants exposed to stressors including food insecurity and experiences of discrimination had higher baseline depression, stress, and anxiety scores. Those with experiences of discrimination, food insecurity, and SARS-CoV-2 infection during pregnancy were more likely to have improvements in mental health scores postintervention. CONCLUSION In this diverse urban cohort, a novel community-based intervention was associated with improvements in depressive symptoms, perceived stress, and anxiety, particularly among those with social determinants of health.
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Affiliation(s)
- Molly R Siegel
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow).
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras)
| | - Kaitlyn E James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow)
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras)
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras)
| | - Hannah Swift
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Joon Kim
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Olyvia J Jasset
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Lydia L Shook
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow); Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow)
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras); Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA (Dr Taveras); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (Dr Taveras)
| | - Andrea G Edlow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow); Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA (Mses Swift, Kim, and Jasset and Drs Shook and Edlow).
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Zaman A, Ovalle B, Reyes C, Segall-Gutierrez P. Enhanced Participation in Diabetes Screening and Care After Gestational Diabetes Through Community Health Workers: Results from the Es Mejor Saber Randomized Controlled Trial. J Immigr Minor Health 2024; 26:45-53. [PMID: 37878217 PMCID: PMC10842185 DOI: 10.1007/s10903-023-01547-5] [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] [Accepted: 09/16/2023] [Indexed: 10/26/2023]
Abstract
Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus, but many women with GDM do not return for postpartum diabetes screening. Interventions utilizing community health workers have demonstrated improvements in health knowledge and participation in other disease settings. The objective of this study was to therefore determine whether bilingual, bicultural community health workers (i.e., promotoras) increase participation in postpartum disease screening and referral for diabetes prevention or care in an urban, low-resource Hispanic community. Ninety-four women with GDM were recruited from the postpartum ward of a safety-net hospital and randomized equally to receive either standard-of-care alone or standard-of-care with a promotora-based intervention consisting of education, appointment reminders, and assistance navigating the healthcare system. Adherence to diabetes screening visits by 12 weeks postpartum and referral for preventive or diabetes care by 18 weeks postpartum was assessed through electronic medical record review. Compared to controls, women in the promotora group completed more diabetes screening visits (74% vs. 96%; relative risk [RR] 3.9; 95% Confidence Interval [CI] 1.1-14.1; p = 0.04). Among those who completed diabetes screening visits, women in the promotora group were also more likely to complete a subsequent referral visit for preventive or diabetes care (17% vs. 83%; RR 4.0; 95% CI 2.1-7.4; p < 0.01). A promotora-based intervention consisting of bilingual, bicultural community health workers improved diabetes screening, prevention, and treatment visits in a resource-limited community of Hispanic women with GDM. ClinicalTrials.gov Identifier: NCT00998595.
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Affiliation(s)
- Adnin Zaman
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado, Anschutz Medical Campus, Mailstop C263, 12348 E. Montview Blvd, Aurora, CO, 80045, USA.
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Blanca Ovalle
- Department of Obstetrics and Gynecology,, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carolina Reyes
- Department of Obstetrics and Gynecology,, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Penina Segall-Gutierrez
- Department of Obstetrics and Gynecology,, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Rogers HJ, Ao CSEH, Henry A. Perspectives of women and partners from migrant and refugee backgrounds accessing the Cross Cultural Worker Service in maternity and early childhood services-a survey study. BMC Health Serv Res 2023; 23:1233. [PMID: 37946230 PMCID: PMC10636916 DOI: 10.1186/s12913-023-10194-3] [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] [Received: 06/15/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Women from migrant and refugee backgrounds living in high-income countries have increased risk of adverse perinatal outcomes and report lower satisfaction with perinatal healthcare. In Sydney, Australia, a new service known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service) was implemented to support such women and families from pregnancy to the early parenting period. This study aimed to ascertain the experiences of women and their partners engaging with the CCW Service. METHODS A survey study was undertaken. Women accessing the CCW Service were recruited during pregnancy and were asked to complete surveys at three time points: in the third trimester of pregnancy, at 6 and 12 months postpartum. Their partners were invited to complete a survey at 6 months postpartum. Survey data were analysed to compare satisfaction, usefulness, number of CCW interactions, cultural sensitivity, and service improvement recommendations across all three survey timepoints. RESULTS A total of 231 surveys were received: 113 during pregnancy, 50 at 6-months postpartum, 44 at 12-months postpartum, and 24 partner surveys. Participants in all surveys reported the CCW Service to be useful (84-94%), stating that it increased their understanding of pregnancy, birth and parenting (95-100%), and that they would recommend the CCW Service (92-98%). Participants experienced a high level of satisfaction (88-95%) irrespective of the number of CCW interactions (p = 0.42). Thoughts on becoming a mother or parent were more positive after meeting the CCW than before for both women (p = 0.01) and partners (p = 0.12). Suggestions for CCW Service improvement were to 1) increase the provision of information, specifically financial entitlements, postnatal depression, and support services, 2) increase involvement of partners in care, 3) increase the CCW workforce/or number of CCWs. CONCLUSION The CCW Service was associated with positive experiences and high rates of satisfaction at all timepoints. This service has the potential to inform the implementation of similar models of care that improve accessibility, the perinatal experience, and respond to the unique needs of women and families from migrant and refugee backgrounds.
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Affiliation(s)
- Helen J Rogers
- Child, Youth & Family Services, South Eastern Sydney Local Health District, Sydney, NSW, 2010, Australia.
- Discipline of Women's Health, School of Clinical Medicine, University of NSW (UNSW), Sydney, NSW, 2000, Australia.
| | - Caroline S E Homer Ao
- Maternal and Child Health, Burnet Institute, Melbourne, Vic, 3004, Australia
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney), Sydney, NSW, 2007, Australia
| | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, University of NSW (UNSW), Sydney, NSW, 2000, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, 2217, Australia
- Australia Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, 2042, Australia
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7
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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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8
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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; 229:160.e1-160.e8. [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] [MESH Headings] [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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9
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Harris SA, Harrison M, Hazell-Raine K, Wade C, Eapen V, Kohlhoff J. Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review. Infant Ment Health J 2023. [PMID: 37422890 DOI: 10.1002/imhj.22075] [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: 09/08/2022] [Revised: 04/07/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.
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Affiliation(s)
- Sophia A Harris
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Michelle Harrison
- Parenting Research Centre, Melbourne, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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10
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Cameron NA, Everitt IK, Lee KA, Yee LM, Khan SS. Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention. Hypertension 2023; 80:1162-1170. [PMID: 36960717 PMCID: PMC10192076 DOI: 10.1161/hypertensionaha.122.19317] [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: 03/25/2023]
Abstract
Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine (N.A.C.), Northwestern University Feinberg School of Medicine
| | - Ian K Everitt
- Department of Medicine, Division of Hospital Medicine (I.K.E.), Northwestern University Feinberg School of Medicine
| | - Kristen A Lee
- Department of Medicine, McGaw Medical Center of Northwestern University (K.A.L.)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (L.M.Y.), Northwestern University Feinberg School of Medicine
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology (S.S.K.), Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine (S.S.K.), Northwestern University Feinberg School of Medicine
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11
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DiTosto JD, Roytman MV, Dolan BM, Khan SS, Niznik CM, Yee LM. Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective. Clin Obstet Gynecol 2023; 66:132-149. [PMID: 36657050 PMCID: PMC9869461 DOI: 10.1097/grf.0000000000000759] [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: 01/21/2023]
Abstract
Gestational diabetes mellitus and hypertensive disorders in pregnancy are adverse pregnancy outcomes (APOs) that affect 15% of pregnancies in the United States. These APOs have long-term health implications, with greater risks of future cardiovascular and chronic disease later in life. In this manuscript, we review the importance of timely postpartum follow-up and transition to primary care after APOs for future disease prevention. We also discuss interventions to improve postpartum follow-up and long-term health after an APO. In recognizing racial and ethnic disparities in APOs and chronic disease, we review important considerations of these interventions through a health equity lens.
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Affiliation(s)
- Julia D. DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maya V. Roytman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Loyola University Chicago, Chicago, IL
| | - Brigid M. Dolan
- Division of General Internal Medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S. Khan
- Division of Cardiology, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charlotte M. Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
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12
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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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13
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Phillips SEK, Celi AC, Wehbe A, Kaduthodil J, Zera CA. Mobilizing the fourth trimester to improve population health: interventions for postpartum transitions of care. Am J Obstet Gynecol 2022:S0002-9378(22)02587-X. [PMID: 36574875 DOI: 10.1016/j.ajog.2022.12.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Birthing people in the United States, particularly those from marginalized communities, experience an unexpectedly high rate of morbidity and mortality. Optimal postpartum care is an opportunity to address immediate maternal health concerns while providing a connection to further high-value primary care. However, postpartum care in the United States is fragmented and incomplete. In response to this failure, the American College of Obstetricians and Gynecologists has called for obstetricians to develop individualized care plans that facilitate transitions from obstetrical to primary care after delivery. In this clinical opinion, we review previous interventions that have aimed to increase postpartum care engagement and bridge gaps in care. Although numerous interventions have been trialed, few have been both successful and scalable. We provide recommendations on ways to reimagine equitable and effective postpartum care interventions with multidisciplinary collaboration.
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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, MA.
| | - Ann C Celi
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA; Divisions of General Medicine and Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alexandra Wehbe
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Jasmine Kaduthodil
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Chloe A Zera
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
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14
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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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15
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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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