Disparities in Pregnancy Healthcare Utilization Between Hispanic and Non-Hispanic White Women in Rhode Island

Objective To estimate whether postpartum visit attendance was improved in women exposed to a postpartum patient navigation program compared with those who received care immediately prior to the program's initiation, and to assess whether other postpartum health behaviors improved during the intervention period. Methods This is a prospective observational study of women enrolled in a patient navigation program compared to women receiving care prior to the program. Navigating New Motherhood was a postpartum patient navigation program for adult, English-speaking women receiving prenatal care at a Medicaid-based university clinic. In 2015, Navigating New Motherhood introduced a clinic-level change in which a navigator was hired and assumed supportive and logistical responsibilities for enrolled patients between delivery and postpartum visit completion. We compared medical record data from women who enrolled in Navigating New Motherhood to those of women receiving care in the same clinic for one year immediately prior to Navigating New Motherhood. The primary outcome was postpartum visit attendance. Secondary outcomes included WHO Tier 1 or 2 contraception uptake and other health services measures. We conducted bivariable and multivariable analyses. Results Of the 225 women approached for Navigating New Motherhood participation after program initiation, 96.9% (N=218) enrolled; these women were compared to 256 women in the historical cohort. Most women on both groups were racial or ethnic minorities and all had Medicaid insurance. There were no important differences in demographic, clinical, or health services characteristics between groups, though women in Navigating New Motherhood were more likely to transfer into the clinic for prenatal care and to deliver babies admitted to the NICU. The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% vs. 70.3%, p<0.001), a difference that persisted after adjustment for potential confounding factors (aOR 3.57, 95% CI 2.11-6.04). Women in Navigating New Motherhood also were more likely to receive a WHO Tier 1 or 2 contraceptive method (aOR 1.56, 95% 1.02-2.38), postpartum depression screening (aOR 2.82, 95% CI 1.79-4.43), and influenza (aOR 2.10, 95% CI 1.38-3.19) and HPV vaccination (aOR 2.33, 95% CI 1.25-4.33). Conclusions Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.

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“…11,12 Further, Hispanic and non-Hispanic black race or ethnicity have been associated with poor postpartum health care utilization. 5,8,13,14 …”

Section: Introductionmentioning

confidence: 99%

Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic

Yee¹,

Martinez²,

Nguyen³

et al. 2017

Obstetrics &Amp; Gynecology

102

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“…Although this information is usually integrated into the prenatal care experience in many countries, Hispanic 1 women in the United States initiate prenatal care at a lower rate than non-Hispanic Whites, possibly due to limited access to health care as well as Spanish-speaking providers (Bromley, Nunes, & Phipps, 2012;Johnson-Kozlow, 2010;Yoon, Grumbach, & Bindman, 2004). To address this issue, the authors conducted a study of a promotores de salud (community health worker)-led health education program supplemented by a calendar with maternal and infant health information.…”

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confidence: 99%

Engaging Community WithPromotores de Saludto Support Infant Nutrition and Breastfeeding Among Latinas Residing in Los Angeles County:Salud con Hyland's

Rios-Ellis

Nguyen-Rodriguez

Espinoza

et al. 2014

Health Care for Women International

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The Salud con Hyland's Project: Comienzo Saludable, Familia Sana [Health With Hyland's Project: Healthy Start, Healthy Family],was developed to provide education and support to Latina mothers regarding healthy infant feeding practices and maternal health. The promotora-delivered intervention was comprised of two charlas (educational sessions) and a supplemental, culturally and linguistically relevant infant feeding and care rolling calendar. Results indicate that the intervention increased intention to breastfeed exclusively, as well as to delay infant initiation of solids by 5 to 6 months. Qualitative feedback identified barriers to maternal and child health education as well as highlighted several benefits of the intervention.

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“…47 Undocumented Hispanic or Latino immigrants with HIV are at higher risk for opportunistic infections, HIV diagnosis, 48 and late diagnosis 49 compared with nonimmigrant Hispanics. Hispanic women also have lower rates of accessing recommended early prenatal care and postpartum care, 50 although overall perinatal outcomes are better than in other minority subgroups.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Disparities in Antiretroviral Treatment Among HIV-Infected Pregnant Medicaid Enrollees, 2005–2007

Zhang¹,

Senteio

Felizzola

et al. 2013

Am J Public Health

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Objectives We examined racial/ethnic differences in prenatal antiretroviral (ARV) treatment among 3259 HIV-infected pregnant Medicaid enrollees. Methods We analyzed 2005–2007 Medicaid claims data from 14 southern states, comparing rates of not receiving ARVs and suboptimal versus optimal ARV therapy. Results More than one third (37.3%) had zero claims for ARV drugs. Three quarters (73.4%) of 346 Hispanic women received no prenatal ARVs. After we adjusted for covariates, Hispanic women had 3.89 (95% confidence interval = 2.58, 5.87) times the risk of not receiving ARVs compared with Whites. Hispanic women often had only 1 or 2 months of Medicaid eligibility, perhaps associated with barriers for immigrants. Less than 3 months of eligibility was strongly associated with nontreatment (adjusted odds ratio = 29.0; 95% confidence interval = 13.4, 62.7). Conclusions Optimal HIV treatment rates in pregnancy are a public health priority, especially for preventing transmission to infants. Medicaid has the surveillance and drug coverage to ensure that all HIV-infected pregnant women are offered treatment. States that offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent HIV in children.

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Disparities in Pregnancy Healthcare Utilization Between Hispanic and Non-Hispanic White Women in Rhode Island

Cited by 22 publications

References 13 publications

Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic

Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic

Engaging Community WithPromotores de Saludto Support Infant Nutrition and Breastfeeding Among Latinas Residing in Los Angeles County:Salud con Hyland's

Racial/Ethnic Disparities in Antiretroviral Treatment Among HIV-Infected Pregnant Medicaid Enrollees, 2005–2007

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