1
|
Gregory EF, Beidas RS, Fiks AG, Lorch SA, Levine LD, Rubin DM, Maddox AI, O'Sullivan AL, Wu KK, Cronholm PF. Acceptability of Dyad Care Management After Preterm Birth: A Qualitative Study. Matern Child Health J 2024; 28:351-361. [PMID: 37980700 PMCID: PMC11197049 DOI: 10.1007/s10995-023-03848-5] [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: 11/02/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Care management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable. METHODS We conducted qualitative interviews with women with a history of preterm birth and clinicians. For women with a history of preterm birth, additional inclusion criteria were Medicaid-insured infant in one health system and English proficiency. We purposively oversampled women whose infants received care management. Clinicians worked in two geographically adjacent health systems. Interviews explored priorities after preterm birth and perceived acceptability of mother-infant dyad care management. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes and captured emergent themes. RESULTS We interviewed 33 women (10/2018-7/2021) and 24 clinicians (3/2021-8/2021). Women were predominantly non-Hispanic Black, and 15 had infants receiving care management. Clinicians included physicians, nurses, and social workers from Pediatrics, Obstetrics, and Family Medicine. Subgroups converged thematically, finding care management acceptable. Tailoring programs to address stress and sleep, emphasizing care managers with strong interpersonal skills and shared experiences with care management users, and program flexibility would contribute to acceptability. CONCLUSIONS FOR PRACTICE Dyad care management after preterm birth is acceptable to potential program end-users and clinicians. Dyad health promotion may contribute to improved birth outcomes, infant, and parent health.
Collapse
Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Research Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David M Rubin
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ann L O'Sullivan
- University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - Katherine K Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| |
Collapse
|
2
|
Pennington EL, Barner JC, Brown CM, Lawson KA. Pregnancy-related risk factors and receipt of postpartum care among Texas Medicaid pregnant enrollees: Opportunities for pharmacist services. J Am Pharm Assoc (2003) 2024; 64:260-267.e2. [PMID: 37981070 DOI: 10.1016/j.japh.2023.11.018] [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: 07/15/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The United States (US) experiences the highest rate of maternal mortality of similar countries. Postpartum care (PPC) focused on chronic disease management is potentially lifesaving, especially among pregnancies complicated by risk factors such as diabetes, hypertension, and mental health conditions (MHCs), which are conditions in which pharmacists can have an impact. OBJECTIVE To evaluate the prevalence of maternal mortality risk factors and their relationships with receipt of PPC among Texas Medicaid enrollees. METHODS A retrospective study included women with a delivery between 3/25/2014-11/1/2019 who were continuously enrolled in Texas Medicaid during the study period from 84 days pre-delivery to 60 days post-delivery. PPC was defined as ≥1 visit associated with postpartum follow-up services. Maternal mortality risk factors (diabetes, hypertension, and MHCs) during and after pregnancy were identified using diagnoses and medication utilization. Age, race/ethnicity, cesarean delivery, and preterm birth served as covariates. Multivariable logistic regression was used to address the study objective. RESULTS The sample (N = 617,010) was 26.5±5.7 years, primarily (52.8%) Hispanic, and 33.0% had cesarean deliveries and 9.3% had preterm births. Risk factor prevalence included: diabetes (14.0%), hypertension (14.3%), and MHCs during (6.3%) and after (9.1%) pregnancy. A majority (77.9%) had a PPC visit within 60 days of delivery. The odds of receiving PPC were 1.2 times higher for patients with diabetes (OR = 1.183; 95% CI = 1.161-1.206; P < 0.0001), 1.1 times higher for patients with hypertension (OR = 1.109; 95% CI= 1.089-1.130; P < 0.0001), and 1.1 times higher for patients with MHCs (OR=1.138; 95% CI = 1.108-1.170; P < 0.0001) than patients without, respectively. CONCLUSION Over three-quarters of Texas Medicaid pregnant enrollees received PPC within 60 days of delivery and risk factors were prevalent and predictive of receipt of PPC. Pharmacists can have a positive impact on maternal health by addressing hypertension, diabetes, and MHC risk factors.
Collapse
|
3
|
Gregory EF, Cronholm PF, Levine LD, Beidas RS, DeMarco MP, O'Sullivan AL, Lorch SA, Maddox AI, Wu K, Fiks AG. Integrating Care for Mother-Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:642-650. [PMID: 38155873 PMCID: PMC10754422 DOI: 10.1089/whr.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/30/2023]
Abstract
Objective There are gaps in receipt of maternal preventive services in the interconception period. Yet mother-infant dyads have frequent health care visits. Health systems have opportunities to better capitalize on existing visits to address dyad needs, but this possibility has not been fully explored. Methods In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing parents or infants after preterm birth. We conducted snowball sampling from teams in pediatrics, obstetrics, and family medicine at two geographically adjacent health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across adult and infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach. Results We interviewed 24 physicians, nurses, midwives, and social workers (March-November 2021). Participants identified barriers to integrated care including infrequent communication between clinical teams, which was generalizable to care of the birthing parent or infant as individuals, and additional barriers related to privacy, credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and procedures currently used in their practices, including electronic health record tools for communication, dedicated roles to support communication or navigation, centralized information on resources for dyad care, referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect face-to-face about shared patients or families. Conclusions Clinicians believe existing health care structures and processes can be adapted to address current substantial barriers to integrated dyad care.
Collapse
Affiliation(s)
- Emily F. Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa D. Levine
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mario P. DeMarco
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ann L. O'Sullivan
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, PA
| | - Scott A. Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I. Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G. Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Bose-Brill S, Gillespie SL, Venkatesh KK. Can We Implement Multispecialty Mother-Infant Dyadic Care to Systematize Interpregnancy Services After a Preterm Birth? WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:651-655. [PMID: 38155872 PMCID: PMC10754421 DOI: 10.1089/whr.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Seuli Bose-Brill
- Combined Internal Medicine and Pediatrics Section, Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Shannon L. Gillespie
- The Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K. Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| |
Collapse
|
5
|
Scott K, Gregory EF, Burris HH. Addressing Maternal Mortality in the US-A Pediatrics Responsibility. JAMA 2023; 329:1819-1820. [PMID: 37155191 DOI: 10.1001/jama.2023.6234] [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: 05/10/2023]
Abstract
This Viewpoint suggests that pediatricians’ contact with the maternal-infant dyad postpartum presents an opportunity to address the US maternal mortality crisis and its inequities.
Collapse
Affiliation(s)
- Kristan Scott
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
| |
Collapse
|
6
|
Larsen AL, Lorch SA, Passarella M, Gregory EF. Prevalence and Predictors of Integrated Care Among Teen Mothers and Their Infants. J Adolesc Health 2022; 71:474-479. [PMID: 35778353 PMCID: PMC9489675 DOI: 10.1016/j.jadohealth.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/10/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Integrated models of primary care for parenting teens, in which teens and infants are cared for by the same clinical team on the same day, are associated with reduced repeated pregnancies and increased uptake of contraception and immunization. Our purpose was to determine how frequently teen-infant dyads receive integrated care. METHODS This study used Medicaid Analytic eXtract data to create a retrospective cohort of mothers aged 12-17 linked with infants born from 2007-2012 in 12 states. Teen-infant dyads were enrolled in Medicaid throughout the year after birth. The primary outcome was integrated care in the year after birth, defined as ≥ 1 instance when teen and infant had visits on the same day, billed to the same clinician identifier. Logistic regression assessed the relationship between integrated care and maternal demographics, dyad health, clinician specialty, and community factors. RESULTS Of 20,203 dyads, 3,371 (16.7%) had integrated care in the year after birth. Dyads with integrated care had a mean of 1.2 (SD 1.3) integrated visits. Dyads with integrated care had more visits (14.9, SD 10.6 vs. 11.7, SD 8.3), including more preventive visits for teens and more acute visits for both teens and infants. In regression, integrated care was associated with maternal factors (younger age, non-Latinx white race, and maternal health risks), residence in rural or high-poverty areas, and ever visiting Family Medicine clinicians. DISCUSSION Though uncommon, integrated care was associated with greater engagement in health care. Implementation of integrated care may support increased preventive care for parenting teens.
Collapse
Affiliation(s)
- Alexandra L Larsen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A Lorch
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Emily F Gregory
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| |
Collapse
|
7
|
Early childhood antibiotic utilization for infants discharged from the neonatal intensive care unit. J Perinatol 2022; 42:953-958. [PMID: 35383276 PMCID: PMC9262761 DOI: 10.1038/s41372-022-01380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine antibiotic utilization for NICU infants, as compared to non-NICU infants, in the first 3 years after birth hospital discharge. STUDY DESIGN Retrospective observational study using data from Medicaid Analytic Extract including 667 541 newborns discharged from 2007-2011. Associations between NICU admission and antibiotic prescription were assessed using regression models, adjusting for confounders, and stratified by gestational age and birth weight. RESULTS 596 999 infants (89.4%) received ≥1 antibiotic, with a median of 4 prescriptions per 3 person-years (IQR 2-8). Prescribed antibiotics and associated indication were similar between groups. Compared to non-NICU infants (N = 586 227), NICU infants (N = 81 314) received more antibiotic prescriptions (adjusted incidence rate ratio 1.08, 95% confidence interval [CI] (1.08,1.08)). Similar results were observed in all NICU subgroups. CONCLUSIONS Antibiotic utilization in early childhood was higher among infants discharged from NICUs compared to non-NICU infants.
Collapse
|
8
|
Gregory EF, Passarella M, Levine LD, Lorch SA. Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women. J Womens Health (Larchmt) 2022; 31:826-833. [PMID: 35231191 DOI: 10.1089/jwh.2021.0355] [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: 11/12/2022] Open
Abstract
Background: Pregnancy complications may recur and are associated with potentially modifiable risks. The role of interconception preventive care in reducing repeat pregnancy complications is understudied. Materials and Methods: This retrospective cohort used 2007-2012 Medicaid claims from 12 states. Included women who had an index birth complicated by prematurity, hypertension, or diabetes, a subsequent birth within 36 months, and Medicaid eligibility for ≥11 of 12 months after index birth. Logistic regression assessed for an association between the exposure of preventive visits in the year after index birth and primary outcomes of prematurity, hypertension, or diabetes in the subsequent pregnancy. Regression adjusted for confounders including demographics (age, race and ethnicity, rural residence, state), index pregnancy features (complications, prenatal visits, multiple gestation, maternal and infant length of stay, year), visits to address complications in the index birth, and interpregnancy interval. Results: Of 17,372 women, mean age was 24.3 ± 5.3 years, and race/ethnicity was 50.3% non-Hispanic White, 27.2% non-Hispanic Black, and 11.9% Hispanic. In the index pregnancy 43.3% experienced prematurity, 39.2% experienced hypertension, and 34.2% experienced diabetes. In the year after the index pregnancy, 54.7% had at least one preventive visit. In the second pregnancy, 47.7% experienced prematurity, hypertension, or diabetes. Recurrence rates were 28.1% for preterm birth, 38.0% for hypertension, and 48.3% for diabetes. Preventive visits were associated with reduced hypertension in the subsequent pregnancy (OR 0.88, 95% CI 0.82-0.97) but not reduced preterm birth or diabetes. Conclusions: Preventive visits after an index birth complicated by prematurity, hypertension, or diabetes were associated with 10% lower odds of hypertension in a subsequent pregnancy, but not with reductions in diabetes or prematurity. Some complications may be more amenable to interconception preventive services than others.
Collapse
Affiliation(s)
- Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Passarella
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens. J Adolesc Health 2021; 69:315-320. [PMID: 33483235 DOI: 10.1016/j.jadohealth.2020.12.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/21/2020] [Accepted: 12/13/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy. METHODS A continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18 months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth, miscarriage, termination), and continuity with a single clinician. Demographic factors included age, race, ethnicity, primary insurance, and residential zip code. Logistic regression identified factors associated with visits after pregnancy. Separately, for a cohort of 47 parenting teens who received primary care at the same site as their infants, we assessed teen-infant care after birth. RESULTS Teens were predominantly non-Latina black (91%) and Medicaid insured (71%). Before pregnancy, most teens had preventive visits (66%) and reported contraceptive use (65%). After pregnancy, 52% discussed pregnancy decisions within a month, 55% reported contraceptive use, and 64% had any primary care visit. Postpregnancy visits were associated with teen age (<18 vs. ≥18 years odds ratio 2.84, 95% confidence interval 1.17-6.90) and pregnancy outcome (termination vs. live birth odds ratio 4.02, 95% confidence interval 1.47-11.01). Among parenting teens, there were more infant visits than teen visits, and continuity was higher for infants. CONCLUSION In a primary care cohort of pregnant teens, gaps persisted in pediatric clinical follow-up after pregnancy. Particularly in situations where pregnancy led to a birth, pregnancy frequently prompted a transition away from pediatric care.
Collapse
|
10
|
Geissler K, Ranchoff BL, Cooper MI, Attanasio LB. Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits. JAMA Netw Open 2020; 3:e2025095. [PMID: 33170263 PMCID: PMC7656283 DOI: 10.1001/jamanetworkopen.2020.25095] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Improving care during the postpartum period is a clinical and policy priority. During the comprehensive postpartum visit, guidelines recommend delivery of a large number of assessment, screening, and counseling services. However, little is known about services provided during these visits. OBJECTIVE To examine rates of recommended services during the comprehensive postpartum visits and differences by insurance type. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 20 071 093 weighted office-based postpartum visits (645 observations) with obstetrical-gynecological or family medicine physicians from annual National Ambulatory Medical Care Surveys from December 28, 2008, to December 31, 2016, and estimated multivariate regression models to calculate the frequency of recommended services by insurance type, controlling for visit, patient, and physician characteristics. Data analysis was conducted from November 1, 2019, to September 1, 2020. EXPOSURES Visit paid by Medicaid vs other payment types. MAIN OUTCOMES AND MEASURES Visit length and binary indicators of blood pressure measurement, depression screening, contraceptive counseling or provision, pelvic examinations, Papanicolaou tests, breast examinations, medication ordered or provided, referral to other physician, and counseling for weight reduction, exercise, stress management, diet and/or nutrition, and tobacco use. RESULTS A total of 20 071 093 weighted comprehensive postpartum visits to office-based family medicine or obstetrical-gynecological physicians were included (mean patient age, 29.7 [95% CI, 29.1-30.3] years). Of these visits, 34.3% (95% CI, 27.6%-41.1%) were covered by Medicaid. Mean visit length was 17.4 (95% CI, 16.4-18.5) minutes. The most common procedures were blood pressure measurement (91.1% [95% CI, 88.0%-94.2%]), pelvic examinations (47.3% [95% CI, 40.8%-53.7%]), and contraception counseling or provision (43.8% [95% CI, 38.2%-49.3%]). Screening for depression (8.7% [95% CI, 4.1%-12.2%]) was less common. When controlling for visit, patient, and physician characteristics, the only significant difference in visit length or provision of recommended services based on insurance type was a difference in provision of breast examinations (14.7% [95% CI, 8.0%-21.5%] for Medicaid vs 25.6% [95% CI, 19.4%-31.8%] for non-Medicaid; P = .02). CONCLUSIONS AND RELEVANCE These findings suggest that receipt of recommended services during comprehensive postpartum visits is less than 50% for most services and is similar across insurance types. These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period.
Collapse
Affiliation(s)
- Kimberley Geissler
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Brittany L. Ranchoff
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Michael I. Cooper
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Laura B. Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| |
Collapse
|