Barriers to and Facilitators of Postpartum Follow-Up Care in Women with Recent Gestational Diabetes Mellitus: A Qualitative Study

Bennett, Wendy L.; Ennen, Christopher S.; Carrese, Joseph A.; Hill-Briggs, Felicia; Levine, David M.; Nicholson, Wanda K; Clark, Jeanne M.

doi:10.1089/jwh.2010.2233

Cited by 155 publications

(148 citation statements)

References 23 publications

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“…Our study confirmed findings in prior studies, which have reported low rates of obstetric postpartum visit attendance and receipt of screening for type 2 diabetes among women with GDM. 13,17,23 No studies have previously assessed receipt of post-delivery follow-up, such as blood pressure screenings for women with preeclampsia, who are at risk for hypertension, cardiovascular and renal disease. 2,24 For all women, postpartum obstetric visit attendance has been recognized 18 as an important indicator of the quality of health care delivery, but it has been difficult to improve through active outreach and incentives.…”

Section: Discussionmentioning

confidence: 99%

“…Table 3 shows the results of the multivariate analyses to determine predictors of receiving primary care after delivery. Among women with Medicaid coverage, statistically significant sociodemographic predictors of primary care after delivery were White race (OR 1.37, p<0.001) or Hispanic ethnicity (OR 1.23, p=0.05), older age (age 25-34: OR 1.28, p<0.001; age > 35: OR 1.42, p<0.001 [reference = age [18][19][20][21][22][23][24]) and living in a neighborhood with a higher proportion of people without a high school diploma (Tertile 3: OR 1.28, p<0.001) ( Table 3). Among women with Medicaid preeclampsia (OR 1.24, p=0.03), DM (OR 1.70, p<0.001) (but not GDM), thyroid disease (OR 1.96, p<0.001), asthma (OR 1.35, p<0.001) and depression (OR 1.25, p=0.01) were predictors.…”

Section: Utilization Of Primary Care In the 12 Months Following Deliverymentioning

confidence: 99%

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Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

et al. 2014

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BACKGROUND: Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended. OBJECTIVE: To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications. RESEARCH DESIGN: Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland. SUBJECTS: 7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy. MEASURES: We compared primary and postpartum obstetric care utilization rates in the 12 months after delivery between the complicated and comparison pregnancy groups. We conducted multivariate logistic regression to assess the association between pregnancy complications, sociodemographic predictor variables and utilization of care, stratified by insurance type. RESULTS: Women with a complicated pregnancy were older at delivery (p<0.001), with higher rates of cesarean delivery (p<0.0001) and preterm labor or delivery (p<0.0001). Among women with Medicaid, 56.6 % in the complicated group and 51.7 % in the comparison group attended a primary care visit. Statistically significant predictors of receiving a primary care visit included non-Black race, older age, preeclampsia or DM, and depression. Among women with commercial health insurance, 60.0 % in the complicated group and 49.5 % in the comparison group attended a primary care visit. Pregnancy complication did not predict a primary care visit among women with commercial insurance. CONCLUSIONS: Women with pregnancy complications were more likely to attend primary care visits postdelivery compared to the comparison group, but overall visit rates were low. Although Medicaid expansion has potential to increase coverage, innovative models for preventive health services after delivery are needed to target women at higher risk for chronic disease development.

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Section: Discussionmentioning

confidence: 99%

Section: Utilization Of Primary Care In the 12 Months Following Deliverymentioning

confidence: 99%

Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

et al. 2014

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“…An example of this was highlighted by Tait Neufeld (2014) when a woman stated that the dietician 'made them feel like a child because she had plastic apples and bananas'. Bennett et al (2011) found that women were more inclined to attend appointments if they had developed positive relationships with their multidisciplinary diabetes care team.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

Exploring the needs, concerns and knowledge of women diagnosed with gestational diabetes: A qualitative study

et al. 2016

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General rights Copyright for the publications made accessible via the Queen's University Belfast Research Portal is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 3 An increased knowledge of the needs and concerns of women with GDM would provide the multidisciplinary diabetes care team and other health care professionals (HCP's), including midwives, with a better understanding on how to support, encourage and educate women to manage their condition more effectively. Long term this could potentially improve pregnancy outcome, helping to reduce the future risk of type 2 diabetes in this population and subsequently pressure on healthcare systems. The aim of this study is therefore to explore the concerns, needs and knowledge of women diagnosed with GDM. Research design and methodsThis qualitative study used focus group methodology, to encourage the generation of ideas and expression of shared experiences and common viewpoints within a group of peers. Eligible participants were identified by the Diabetes Care Team at three National HealthService (NHS) hospitals in the United Kingdom. Women were given an invitation letter at a routine clinic appointment, and those interested in participating completed a permission slip, which allowed the researcher to contact them, and invite them to attend a focus group.Women aged 18-45 years and currently pregnant with GDM, or with a history of GDM in a recent pregnancy (up to 12 months post-natal) were eligible to participate. Those unable to adequately understand verbal explanations in English or who had special communication needs were excluded.Eighty-one women expressed an interest in attending a focus group. Sessions were scheduled at various times and venues in an attempt to suit women and their working and family lives.From this number 38 were enrolled on the study. The remaining women who had expressed an interest in participating were either not able to make it to the scheduled focus group or were no longer contactable. Of the 38 enrolled, five were unwell or in hospital on the day, two delivered before the scheduled session and twelve did not attend the focus group. Focus group discussion topicsThe following topic areas were discussed with the women: 1) current knowledge of GDM; 2)anxiety following the diagnosis of GDM, and whether this changed overtime; 3) understanding and managing GDM and 4) the future impact of GDM. Descriptive qualitative analys...

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“…22,[24][25][26][27][28] Low-income women-who have disproportionate prevalence of gestational diabetes and hypertensive disorders in pregnancy 4,[29][30] -have multiple barriers to outpatient follow-up in the postpartum period. 31 These barriers include lack of childcare, schedule demands, difficulty accessing care, and lack of understanding about the long-term health risks associated with pregnancy complications 31 and may increase women's reliance on emergency room (ER) settings. [32][33] However, ER visits are often more costly, less efficient, and less equipped for longitudinal care of chronic medical diagnoses.…”

Section: In 2008 Inmentioning

confidence: 99%

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Harris

Chang

Wang

et al. 2015

Journal of Women's Health

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Background: Women with pregnancy complications benefit from closer monitoring postpartum and beyond. Increased postpartum emergency room (ER) use may indicate unmet need for outpatient obstetrics and primary care. The purpose of this study was to evaluate whether women with pregnancy complications (gestational diabetes [GDM], gestational hypertension, and preeclampsia) have increased ER use in the first 6 months postpartum, compared with women without these complications. Methods: We conducted a retrospective population-based cohort study using a 2003-2010 Maryland Medicaid managed care claims data set, linked with U.S. Census data. Data included claims for outpatient and ER visits for women aged 12-45 years who were continuously enrolled in Medicaid for at least 100 days of pregnancy and 90 days postpartum. We used logistic regression to calculate the association between pregnancy complications and having ‡1 ER visit in the 6 months postpartum. Results: We identified 26,074 pregnancies, of which 20% were complicated by GDM, gestational hypertension, or preeclampsia. Of these complicated pregnancies, 42.1% had GDM, 35.4% had gestational hypertension, and 42.5% had preeclampsia (diagnoses were not mutually exclusive). In the 6 months postpartum, 25% of women had ‡1 ER visits. Of the complicated pregnancy group, 27.7% had ‡1 ER visit, versus 23.6% of the comparison group ( p < 0.0001). In adjusted analyses, women with a pregnancy complication were more likely to have ‡1 ER visit compared with women without these complications (odds ratio [OR]1.14, 95% confidence interval [CI] 1.05-1.23). The strength of association was highest in women under age 25 (OR 1.20, 95% CI 1.09-1.33). Preconception medical comorbidities (type 2 diabetes, chronic hypertension, obesity, asthma, mental health, and substance abuse diagnoses) were also strongly associated with postpartum ER use (OR 1.61, 95% CI 1.51-1.73). Conclusions: Pregnancy complications increased ER utilization during the 6 months postpartum, especially among women under age 25 years. Interventions that improve discharge planning and early postpartum care may decrease ER use.

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Barriers to and Facilitators of Postpartum Follow-Up Care in Women with Recent Gestational Diabetes Mellitus: A Qualitative Study

Cited by 155 publications

References 23 publications

Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

Exploring the needs, concerns and knowledge of women diagnosed with gestational diabetes: A qualitative study

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

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