Using Telehealth Approaches to Address Social Determinants of Health and Improve Pregnancy and Postpartum Outcomes

Dixon-Shambley, Kamilah; Gabbe, Patricia Temple

doi:10.1097/grf.0000000000000611

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Beyond the preoperative phase of care, the surgeon’s office should aim to ease access to postoperative care. Practice-wide enhancements such as a nurse-operated hotline for urgent questions and the availability of telehealth visits can potentially reduce unnecessary postoperative hospital use and ease the clinical burden for patients with limited social connections, transportation, and work-related time constraints 27 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty

Rahman,

Shaw,

Mehaidli

et al. 2023

Journal of Bone and Joint Surgery

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Background: Social determinants of health (SDOH) are important factors in the delivery of orthopaedic care. The purpose of this study was to investigate the relationship between outcomes following total knee arthroplasty (TKA) and both the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI). Methods: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was utilized to identify TKA cases for inclusion. Demographic characteristics and medical history were documented. The SVI, its subthemes, and the ADI were analyzed. Outcome data included length of stay, discharge disposition, postoperative change in the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), 90-day incidences of emergency department (ED) visits, readmission, death, deep venous thrombosis (DVT) and/or pulmonary embolism (PE), periprosthetic fracture, implant failure, periprosthetic joint infection (PJI), and all-cause reoperation. Database cross-referencing was completed to document aseptic and septic revisions beyond 90 days postoperatively. Bivariate quartile-stratified and multivariable analyses were used to associate deprivation metrics with outcomes. Results: A total of 19,321 TKA cases met inclusion criteria. Baseline patient characteristics varied among the SVI and/or ADI quartiles, with patients of non-White race and with a greater number of comorbidities noted in higher deprivation quartiles. Higher SVI and/or ADI quartiles were correlated with an increased rate of discharge to a skilled nursing facility (p < 0.05). A higher SVI and/or ADI quartile was associated with increased incidences of ED visits and readmissions postoperatively (p < 0.05). DVT and/or PE and long-term aseptic revision were the complications most strongly associated with higher deprivation metrics. Upon multivariable analysis, greater length of stay and greater incidences of ED visits, readmissions, DVT and/or PE, and aseptic revision remained significantly associated with greater deprivation based on multiple metrics. Conclusions: Greater deprivation based on multiple SVI subthemes, the composite SVI, and the ADI was significantly associated with increased length of stay, non-home discharge ED visits, and readmissions. The SVI and the ADI may be important considerations in the perioperative assessment of patients who undergo TKA. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty

Rahman,

Shaw,

Mehaidli

et al. 2023

Journal of Bone and Joint Surgery

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“…In the wake of the COVID-19 pandemic, telehealth has become a necessary method of healthcare delivery. Telehealth has become a more viable option for the general population, and more specifically for hard to reach populations including new parents [136], under-resourced populations [137], and those facing mental health stigma. Social support has shown to have a significant impact on postpartum mental wellbeing, and isolation as a result of social distancing is a risk factor for developing postpartum depression [138].…”

Section: Alternative Methods Of Treatment Deliverymentioning

confidence: 99%

Postpartum Depression: Overcoming Mental Health Challenges during Parenthood

Walls¹,

Leiferman²,

Farewell³

et al. 2023

Health

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Postpartum depression affects parents across all social, economic, and racial groups. While there are many factors that may contribute to depressive symptoms in the postpartum period, under-resourced populations and ethnic minorities are documented to experience higher rates. Traditional psychotherapeutic methods have shown success in mitigating depressive symptoms; however, these treatments are not always accessible and/or utilized, particularly in populations with the highest need. Mind-body interventions have become increasingly popular in addressing perinatal mental health, and new and innovative approaches are currently being evaluated to determine their efficacy with respect to treating postpartum depression. This scoping review highlights published clinical trials, interventions, meta-analyses, and reviews conducted in the last 20 years and examines how each method applies to meet the needs of postpartum parents, and particularly under-resourced populations.

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“…However, this study excluded women without access to a computer [ 91 ]. Studies from other settings have also reported improved access [ 48 , 72 , 92 , 93 ]. Conversely, Osarhiemen et al [ 94 ] identified that while telehealth did not mitigate inequities in access, it also did not widen existing disparities in the USA.…”

Section: Consumer Satisfactionmentioning

confidence: 99%

Telehealth in antenatal care: recent insights and advances

Atkinson,

Hastie,

Walker

et al. 2023

BMC Med

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Background For decades, antenatal care in high-resource settings has involved 12–14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care. Main body We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers. Conclusion Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality.

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Using Telehealth Approaches to Address Social Determinants of Health and Improve Pregnancy and Postpartum Outcomes

Cited by 9 publications

References 28 publications

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty

Postpartum Depression: Overcoming Mental Health Challenges during Parenthood

Telehealth in antenatal care: recent insights and advances

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