Use of Postpartum Care: Predictors and Barriers

DiBari, Jessica; Yu, Stella M.; Chao, Shin Margaret; Lu, Michael C.

doi:10.1155/2014/530769

Cited by 117 publications

(101 citation statements)

References 10 publications

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“…It is not clear if disparities reflect within-or between-provider effects or unmeasured morbidity. Disparities in receipt of postpartum maternal care are larger than the hospital-based disparities (14,38,117).…”

Section: Obstetrical Carementioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

367

232

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The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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Section: Obstetrical Carementioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

367

232

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“…1-3 Nonetheless, postpartum appointment attendance is poor 1,4 , and substantial disparities in postpartum care uptake exist based on insurance type, race and ethnicity, level of education, age, and socioeconomic status. 5-10 Data from the National Committee on Quality Assurance demonstrated that approximately 80% of women with commercial insurance completed a postpartum visit while only 60% of Medicaid enrollees did so. 11,12 Further, Hispanic and non-Hispanic black race or ethnicity have been associated with poor postpartum health care utilization.…”

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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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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“…Women who intend to use an intrauterine device (IUD) for postpartum contraception are often unable to return for a postpartum visit, and never receive anIUD. 3 These women are more likely to be socially and financially disadvantaged 4,5 and face barriers such as lack of transportation, lack of stable housing, and difficulty communicating with their healthcare providers. 6 …”

Section: Introductionmentioning

confidence: 99%

Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum

Levi

Stuart

Zerden

et al. 2015

Obstetrics & Gynecology

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Objective To compare intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean delivery (during cesarean delivery) IUD placement versus women who planned for interval IUD placement 6 or more weeks postpartum. Methods In this non-blinded randomized trial women who were undergoing a cesarean and desired an IUD were randomized to intracesarean cesarean delivery or interval IUD placement. The primary outcome was IUD use at 6 months postpartum. A sample size of 112 (56 in each group) was planned to detect a 15% difference in IUD use at 6 months postpartum between groups. Results From March 2012 to June 2014, 172 women were screened and 112 women were randomized into the trial. Baseline characteristics were similar between groups. Data regarding IUD use at 6 months postpartum was available for 98 women, 48 and 50 women in the intracesarean and interval groups, respectively. A larger proportion of the women in the intracesarean group were using an IUD at 6 months postpartum ((40/48), 83%) compared to those in the interval group ((32/50) 64%, relative risk [RR]=1.3, 95% confidence interval [CI]: 1.02, 1.66). Among the 56 women randomized to interval IUD insertion, 22 (39%) of them never received an IUD; 14 (25%) never returned for IUD placement, five (9%) women declined an IUD, and three (5%) had a failed IUD placement. Conclusion IUD placement at the time of cesarean delivery leads to a higher proportion of IUD use at 6 months postpartum when compared to interval IUD placement.

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Use of Postpartum Care: Predictors and Barriers

Cited by 117 publications

References 10 publications

Racial and Ethnic Disparities in the Quality of Health Care

Racial and Ethnic Disparities in the Quality of Health Care

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

Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum

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