A Systematic Review of Patient-, Provider-, and Health System-Level Predictors of Postpartum Health Care Use by People of Color and Low-Income and/or Uninsured Populations in the United States

Wouk, Kathryn; Morgan, Isabel; Johnson, Jeff; Tucker, Christine; McCall, Rebecca; Berry, Diane; Stuebe, Alison M.

doi:10.1089/jwh.2020.8738

Cited by 26 publications

(37 citation statements)

References 68 publications

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“…61 Improving PCC practice is not enough to ensure optimal postpartum care; infrastructure and policy change are also required. 64,65 First and foremost, universal health insurance for the entire year after pregnancy is essential. 60 Comparisons between Medicaid expansion and non-expansion states suggest that extending the duration of postpartum health insurance leads to increased outpatient follow-up, especially after medically complicated pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

et al. 2022

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Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. We therefore conducted a systematic review of US clinical practice guidelines and professional society recommendations to inform primary care-based CVD risk management after adverse pregnancy outcomes. We identified 13 relevant publications. While most recommendations were based on limited or weak evidence, we identified several areas of consensus. First, individuals with an adverse pregnancy outcome associated with future CVD are likely to benefit from CVD risk assessment-accompanied by education, counseling, and support for lifestyle modification-beginning within the first postpartum year. Second, among clinicians, clear and consistent documentation about adverse pregnancy outcomes and recommended follow-up is important to coordinate care after pregnancy. In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.

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Section: Discussionmentioning

confidence: 99%

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

et al. 2022

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“…We drew from our prior systematic review 33 of patient-level, provider-level, and health center-level predictors of postpartum care use in marginalized populations to enumerate potential variables associated with receiving guideline-concordant quality postpartum care.…”

Section: Methodsmentioning

confidence: 99%

Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Wouk

Kinlaw

Farahi

et al. 2022

Women's Health Reports

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Introduction: New clinical guidelines recommend comprehensive and timely postpartum services across 3 months after birth. Research is needed to characterize correlates of receiving guideline-concordant, quality postpartum care in federally qualified health centers serving marginalized populations. Methods: We abstracted electronic health record data from patients who received prenatal health care at three health centers in North Carolina to characterize quality postpartum care practices and to identify correlates of receiving quality care. We used multivariable log-binomial regression to estimate associations between patient, provider, and health center characteristics and two quality postpartum care outcomes: (1) timely care, defined as an initial assessment within the first 3 weeks and at least one additional visit within the first 3 months postpartum; and (2) comprehensive care, defined as receipt of services addressing family planning, infant feeding, chronic health, mood, and physical recovery across the first 3 months. Results: In a cohort of 253 patients, 60.5% received comprehensive postpartum care and 30.8% received timely care. Several prenatal factors (adequate care use, an engaged patient–provider relationship) and postpartum factors (early appointment scheduling, exclusive breastfeeding, and use of enabling services) were associated with timely postpartum care. The most important correlate of comprehensive services was having more than one postpartum visit during the first 3 months postpartum. Discussion: Identifying best practices for quality postpartum care in the health center setting can inform strategies to reduce health inequities. Future research should engage community stakeholders to define patient-centered measures of quality postpartum care and to identify community-centered ways of delivering this care.

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“…Unfortunately, this critical period is complicated by numerous barriers to optimal care, including (1) lack of childcare, (2) experience of discrimination in perinatal care, (3) clinician time limitations, (4) knowledge gaps about the link between APOs and future CVD, (5) postpartum loss of health insurance, and (6) failure of the health care system to facilitate postpartum transition to primary care. [51][52][53] The primary focus here will be on risk-reduction strategies used by patients and their OB/GYN team in the postpartum period. However, an important health care system-level intervention of Multi-disciplinary Postpartum Transitional Clinics can overcome some barriers associated with the postpartum/ primary care transition.…”

Section: Managing the Fourth Trimester And Beyond For Patients With Aposmentioning

confidence: 99%

“…Postpartum care is integral to optimizing acute health outcomes in birthing people and allows for robust screening and continued management of comorbid conditions while facilitating recovery in the puerperium. Unfortunately, this critical period is complicated by numerous barriers to optimal care, including (1) lack of childcare, (2) experience of discrimination in perinatal care, (3) clinician time limitations, (4) knowledge gaps about the link between APOs and future CVD, (5) postpartum loss of health insurance, and (6) failure of the health care system to facilitate postpartum transition to primary care 51–53. The primary focus here will be on risk-reduction strategies used by patients and their OB/GYN team in the postpartum period.…”

Section: Evidence-based Strategies To Mitigate Riskmentioning

confidence: 99%

Adverse Pregnancy Outcomes and Postpartum Care as a Pathway to Future Health

Barry

Johnson

Herrick³

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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Adverse pregnancy outcomes (APOs) collectively represent the leading causes of maternal and neonatal morbidity and mortality. Beyond the potentially devastating impact of APOs during pregnancy and the puerperium, women diagnosed with APOs have a 2-fold to 4-fold increased risk of future cardiovascular disease. Fortunately, APOs occur at an opportune time, in early-adulthood to mid-adulthood, when primary and secondary prevention strategies can alter the disease trajectory and improve long-term health outcomes. This chapter takes a life-course approach to (1) the epidemiology of APOs, (2) evidence-based strategies for clinicians to manage APOs, and (3) future directions for APO research and clinical practice.

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A Systematic Review of Patient-, Provider-, and Health System-Level Predictors of Postpartum Health Care Use by People of Color and Low-Income and/or Uninsured Populations in the United States

Cited by 26 publications

References 68 publications

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Adverse Pregnancy Outcomes and Postpartum Care as a Pathway to Future Health

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