753: Utilization of aspirin for prevention of preeclampsia in a high risk urban cohort

Boelig, Rupsa C.; Wanees, Mariam; Berghella, Vincenzo; Roman, Amanda

doi:10.1016/j.ajog.2019.11.767

Cited by 1 publication

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“…30,31 The findings of our research are generalizable beyond 17OHPC administration and have implications for promotion of other clinical interventions during pregnancy such as vaginal progesterone, cervical length screening, 32 and low-dose aspirin for prevention of PTB/pre-eclampsia. 33 Moreover, whether or not 17OHPC remains on the market, if we are to reduce racial/ethnic disparities in PTB and infant mortality, it is imperative to explore the clinical and social determinants that influence access and acceptability of available treatments for pregnant people with clinical risk factors.…”

Section: Discussionmentioning

confidence: 99%

Patient and Provider Perspectives on Acceptability, Access, and Adherence to 17-Alpha-Hydroxyprogesterone Caproate for Preterm Birth Prevention

Garcia

Kellom

Boelig

et al. 2021

Women's Health Reports

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Background: Preterm birth (PTB) is a pressing maternal and child health issue with long-standing racial inequities in outcomes and care provision. 17-Alpha-hydroxyprogesterone caproate (17OHPC) has been one of few clinical interventions for recurrent PTB prevention. Little is known about the factors influencing successful administration and receipt of 17OHPC among mothers in the Medicaid program. Materials and Methods: We conducted individual semistructured interviews with 17OHPC-eligible pregnant women and obstetric providers from two academic medical centers in Philadelphia, PA. Patient participants were publicly insured, eligible for 17OHPC treatment, and purposively sampled as either (1) actively receiving treatment or (2) declining/discontinuing treatment. Providers had experience providing care to Medicaid-enrolled patients. Interview transcripts were coded and analyzed to identify themes related to treatment acceptability, access, and adherence. Results: Of the 17 patient participants, the mean age was 30 years. Ten providers (MDs, nurse practitioners, and registered nurses) were also interviewed. Factors facilitating 17OHPC uptake and adherence among patients included severity of prior PTB, provider counseling, and coordination among the clinic, pharmacy, and insurance. Pain was cited as the most significant barrier to 17OHPC for patients, while providers perceived social adversity and beliefs about patients' commitment to treatment to be primary patient barriers. For providers, clinical experience and practice guidelines contributed to their use of 17OHPC. Administrative complexity and coordination of services were the primary provider barrier to 17OHPC administration. Conclusions: Patient–provider communication is a primary driver of 17OHPC acceptability and adherence. Comprehensive patient-centered consultation may improve uptake of clinical therapies among pregnant women at high risk for PTB.

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Section: Discussionmentioning

confidence: 99%