Postpartum Care in the Time of COVID-19: The Use of Telemedicine for Postpartum Care

Adams, Ayoka M; Wu, Haisi; Zhang, Faye R; Wajsberg, Julia R.; Bruney, Talitha

doi:10.1089/tmj.2022.0065

Cited by 15 publications

(7 citation statements)

References 18 publications

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“…The postpartum attendance rates in our study were comparable to those reported in a previous US study [ 18 ]. We initially assumed that the in-person visit rate would decrease during the pandemic.…”

Section: Discussionsupporting

confidence: 89%

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Sothornwit

Kaewrudee

Somboonporn

et al. 2023

Heliyon

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Section: Discussionsupporting

confidence: 89%

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Sothornwit

Kaewrudee

Somboonporn

et al. 2023

Heliyon

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“…However, the benefits of telehealth expansion may accrue differentially across rural and other disadvantaged populations that may have less access to high-speed internet and less privacy for telehealth in the home. Furthermore, continued patient access to telehealth services is contingent on payment reforms that support comprehensive postpartum care and make permanent payment parity policies that pay for telehealth at the same rate as in-person visits …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, continued patient access to telehealth services is contingent on payment reforms that support comprehensive postpartum care and make permanent payment parity policies that pay for telehealth at the same rate as in-person visits. [44][45][46] self-reported surveys provide data that are often impossible to discern from administrative and claims data. Third, PRAMS response rates are higher among White participants compared with participants of other racial or ethnic groups and higher based on socioeconomic advantage, and response bias may interact so that patients who are less likely to receive care are also less likely to participate.…”

Section: Clinical and Policy Implicationsmentioning

confidence: 99%

Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US

et al. 2022

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ImportanceLittle is known about the quality of postpartum care or disparities in the content of postpartum care associated with health insurance, rural or urban residency, and race and ethnicity.ObjectivesTo examine receipt of recommended postpartum care content and to describe variations across health insurance type, rural or urban residence, and race and ethnicity.Design, Settings, and ParticipantsThis cross-sectional survey of patients with births from 2016 to 2019 used data from the Pregnancy Risk Assessment Monitoring System (43 states and 2 jurisdictions). A population-based sample of patients conducted by state and local health departments in partnership with the Centers for Disease Control and Prevention were surveyed about maternal experiences 2 to 6 months after childbirth (mean weighted response rate, 59.9%). Patients who attended a postpartum visit were assessed for content at that visit. Analyses were performed November 2021 to July 2022.ExposuresMedicaid or private health insurance, rural or urban residence, and race and ethnicity (non-Hispanic White or racially minoritized groups).Main Outcomes and MeasuresReceipt of 2 postpartum care components recommended by national quality standards (depression screening and contraceptive counseling), and/or other recommended components (smoking screening, abuse screening, birth spacing counseling, eating and exercise discussions) with estimated risk-adjusted predicted probabilities and percentage-point (pp) differences.ResultsAmong the 138 073 patient-respondents, most (59.5%) were in the age group from 25 to 34 years old; 59 726 (weighted percentage, 40%) were insured by Medicaid; 27 721 (15%) were rural residents; 9718 (6%) were Asian, 24 735 (15%) were Black, 22 210 (15%) were Hispanic, 66 323 (60%) were White, and fewer than 1% were Indigenous (Native American/Alaska Native) individuals. Receipt of both depression screening and contraceptive counseling both significantly lower for Medicaid-insured patients (1.2 pp lower than private; 95% CI, –2.1 to –0.3), rural residents (1.3 pp lower than urban; 95% CI, –2.2 to –0.4), and people of racially minoritized groups (0.8 pp lower than White individuals; 95% CI, –1.6 to –0.1). The highest receipt of these components was among privately insured White urban residents (80%; 95% CI, 79% to 81%); the lowest was among privately insured racially minoritized rural residents (75%; 95% CI, 72% to 78%). Receipt of all other components was significantly higher for Medicaid-insured patients (6.1 pp; 95% CI, 5.2 to 7.0), rural residents (1.1 pp; 95% CI, 0.1 to 2.0), and people of racially minoritized groups (8.5 pp; 95% CI, 7.7 to 9.4). The highest receipt of these components was among Medicaid-insured racially minoritized urban residents (34%; 95% CI, 33% to 35%), the lowest was among privately insured White urban residents (19%; 95% CI, 18% to 19%).Conclusions and RelevanceThe findings of this cross-sectional survey of postpartum individuals in the US suggest that inequities in postpartum care content were extensive and compounded for patients with multiple disadvantaged identities. Examining only 1 dimension of identity may understate the extent of disparities. Future studies should consider the content of postpartum care visits.

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“…It is being studied extensively in the postpartum period, especially for treatment of conditions such as postpartum depression and pregnancy-related hypertensive disorders. Telemedicine may also improve low attendance rates (approximately 50%) for postpartum appointments (Adams et al, 2023 ).…”

Section: Purposementioning

confidence: 99%

Postpartum Hepatitis C Linkage to Care Program in a Co-located Substance Use Disorders Treatment Model

Cheedalla,

Hinely,

Roby

et al. 2023

Matern Child Health J

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Purpose Hepatitis C virus (HCV) is increasingly prevalent in pregnancy and among people with substance use disorders (SUD). Highly effective treatments are now available for chronic HCV. Qualifying for HCV treatment often requires preauthorization and several clinical criteria, including laboratory assessment of liver function and other infectious diseases and liver imaging to assess for fibrosis. Linkage to care (LTC) models have been shown to assist with obtaining the necessary clinical information (laboratory assessment/liver imaging) and improving HCV treatment rates in non-pregnant individuals. Description Beginning in December 2020, a specialized LTC team identified patients with HCV viremia who were interested in postpartum treatment. The LTC team assisted patients with completing the necessary clinical criteria (laboratory assessment and liver imaging) for HCV treatment. Patients were then linked to infectious disease specialists who prescribed treatment to patients via telemedicine. Most patients identified with HCV were enrolled in our institution’s co-located obstetric and SUD program, which provides continued care until 1 year postpartum. Assessment In 2019, an internal review identified that none of the 26 pregnant patients with HCV viremia in our co-located obstetric and SUD program were prescribed direct-acting antiviral (DAA) treatment within 12 months postpartum. Between December 2020 and July 2022, our HCV LTC team identified 34 patients with HCV who were eligible for treatment. Of these patients, 55% (19/34) obtained all necessary laboratory and liver imaging requirements and 79% (15/19) were prescribed DAA treatment after a telehealth visit with an infectious disease specialist. All fifteen patients who were prescribed treatment participated in the co-located obstetric and SUD program. The largest barrier to obtaining treatment was completing the necessary laboratory and liver imaging requirements for prescribing DAA. Only one patient who did not receive care in our co-located obstetric and SUD program had completed the necessary laboratory and liver imaging requirements to proceed with treatment but did not follow up with the infectious disease specialist for DAA treatment. Conclusion Our HCV LTC program was successful in treating postpartum patients for HCV if they participated in the co-located obstetric and SUD program at our institution. Creating a partnership with an infectious disease specialist and utilizing telemedicine were beneficial strategies to connect patients to treatment for HCV during the postpartum period.

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Postpartum Care in the Time of COVID-19: The Use of Telemedicine for Postpartum Care

Cited by 15 publications

References 18 publications

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US

Postpartum Hepatitis C Linkage to Care Program in a Co-located Substance Use Disorders Treatment Model

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