Predictors of Non-Attendance to the Postpartum Follow-up Visit

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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“…11,12 Further, Hispanic and non-Hispanic black race or ethnicity have been associated with poor postpartum health care utilization. 5,8,13,14 …”

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

106

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“…Attendance rates at the 6-week postpartum visit are variable, with as many as 33% of prenatal care recipients not returning for postpartum care (1). Postplacental IUD insertion, which refers to IUD insertion within 10 minutes of placental delivery is one potential way to decrease rapid repeat pregnancies (2).…”

Section: Introductionmentioning

confidence: 99%

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Chen

Hou

Hsia

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To evaluate whether a department policy changing the scheduling of the postpartum visit from 6 weeks to 2–3 weeks after delivery is associated with higher long-acting reversible contraception (LARC) initiation at the postpartum visit. Methods We conducted a quasi-experimental before–after study to evaluate LARC initiation, specifically an intrauterine device (IUD) or contraceptive implant, at the postpartum visit between women scheduled for follow-up at 6 weeks (before policy change) and 2–3 weeks after delivery (after policy change). Secondary outcomes included postpartum visit completion, overall contraception initiation at the postpartum visit, overall contraceptive use at 6 months after delivery, and repeat pregnancies by 6 months postpartum. We obtained delivery and postpartum information using the electronic medical record and contacted participants 3 and 6 months after delivery to assess contraception use and repeat pregnancies. Results We enrolled 586 participants between December 2014 and November 2015, of whom 512 women (256 in each cohort) continued to meet eligibility criteria after delivery. Long-acting reversible contraception initiation rates at the postpartum visit were lower in the 2–3 week (16.5%, 95%CI 12.2–21.8) compared to 6-week group (31.1%, 95%CI 25.2–37.7, p<0.01), primarily due to patient and health care provider preferences for delaying IUD insertion to a later visit. More women completed a scheduled 2–3 week postpartum visit (90.2%, 95%CI 86.0–93.3) compared to 6-week visit (81.6%, 95%CI 76.4–85.9, p<0.01). Deferral of any contraception initiation was higher in the 2–3 week group (27.3%, 95%CI: 21.9–33.4) compared to 6-week group (15.8%, 95%CI: 11.5–21.4, p<0.01), but there were no differences in overall contraceptive use patterns at 6 months postpartum. No IUD perforations or expulsions were observed in women who underwent insertion at 2–3 weeks postpartum. Five pregnancies were reported in each cohort by 6 months after delivery. Conclusions Scheduling a visit at 2–3 weeks after delivery was not associated with increased LARC initiation at this visit despite higher postpartum visit attendance.

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“…7 There is evidence to suggest that women who do not follow-up postpartum have access and utilization barriers to care, and limited resources including unstable housing and transportation. 8 Other disparities in postpartum care include lack of prenatal care, insurance, ethnicity, age, and socioeconomic status. [8][9][10][11] It is possible that maternal mental health also contributes to the nonuse of postpartum care.…”

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confidence: 99%

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

2018

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Objective We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. Study Design This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. Results Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99). Conclusion Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.

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Predictors of Non-Attendance to the Postpartum Follow-up Visit

Cited by 132 publications

References 27 publications

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

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

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

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