Correlates of Receiving Guideline-Concordant Postpartum Health Services in the Community Health Center Setting

Abstract

Introduction: New clinical guidelines recommend comprehensive and timely postpartum services across 3 months after birth. Research is needed to characterize correlates of receiving guideline-concordant, quality postpartum care in federally qualified health centers serving marginalized populations. Methods: We abstracted electronic health record data from patients who received prenatal health care at three health centers in North Carolina to characterize quality postpartum care practices and to identify correlates of receiving quality care. We used multivariable log-binomial regression to estimate associations between patient, provider, and health center characteristics and two quality postpartum care outcomes: (1) timely care, defined as an initial assessment within the first 3 weeks and at least one additional visit within the first 3 months postpartum; and (2) comprehensive care, defined as receipt of services addressing family planning, infant feeding, chronic health, mood, and physical recovery across the first 3 months. Results: In a cohort of 253 patients, 60.5% received comprehensive postpartum care and 30.8% received timely care. Several prenatal factors (adequate care use, an engaged patient–provider relationship) and postpartum factors (early appointment scheduling, exclusive breastfeeding, and use of enabling services) were associated with timely postpartum care. The most important correlate of comprehensive services was having more than one postpartum visit during the first 3 months postpartum. Discussion: Identifying best practices for quality postpartum care in the health center setting can inform strategies to reduce health inequities. Future research should engage community stakeholders to define patient-centered measures of quality postpartum care and to identify community-centered ways of delivering this care.

Dyadic Care Mobile Units: A Collaborative Midwifery and Pediatric Response to the COVID‐19 Pandemic

“…They include lack of financial supports for transportation and childcare, lack of perceived benefit of the visit, prior poor experiences with the health care system, and lack of social support. [6][7][8][9][10] The impact of the missed postpartum visit is significant for both the postpartum patient and the newborn. The lost opportunity to identify and treat common perinatal mood disorders such as postpartum anxiety, depression, and posttraumatic stress disorder can have negative effects on infant growth, sleep, neurodevelopment, socio-emotional development, and temperament.…”

“…The reasons for low postpartum visit attendance have been explored in both qualitative and quantitative studies. They include lack of financial supports for transportation and childcare, lack of perceived benefit of the visit, prior poor experiences with the health care system, and lack of social support 6–10 …”