Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Department of Obstetrics and Gynecology, Greenville Health System University Medical Center, Greenville, SC.
Am J Obstet Gynecol. 2014 Jan;210(1):50.e1-7. doi: 10.1016/j.ajog.2013.09.001. Epub 2013 Sep 7.
The objective of the study was to evaluate the impact of group prenatal care (GPNC) on postpartum family-planning utilization.
A retrospective cohort of women continuously enrolled in Medicaid for 12 months (n = 3637) was used to examine differences in postpartum family-planning service utilization among women participating in GPNC (n = 570) and those receiving individual prenatal care (IPNC; n = 3067). Propensity scoring methods were used to derive a matched cohort for additional analysis of selected outcomes.
Utilization of postpartum family-planning services was higher among women participating in GPNC than among women receiving IPNC at 4 points in time: 3 (7.72% vs 5.15%, P < .05), 6 (22.98% vs 15.10%, P < .05), 9 (27.02% vs 18.42%, P < .05), and 12 (29.30% vs 20.38%, P < .05) months postpartum. Postpartum family-planning visits were highest among non-Hispanic black women at each interval, peaking with 31.84% by 12 months postpartum. After propensity score matching, positive associations between GPNC and postpartum family-planning service utilization remained consistent by 6 (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.05-1.92), 9 (OR, 1.43; 95% CI, 1.08-1.90), and 12 (OR, 1.44; 95% CI, 1.10-1.90) months postpartum.
These findings demonstrate the potential that GPNC has to positively influence women's health outcomes after pregnancy and to improve the utilization rate of preventive health services. Utilization of postpartum family-planning services was highest among non-Hispanic black women, further supporting evidence of the impact of GPNC in reducing health disparities. However, despite continuous Medicaid enrollment, postpartum utilization of family-planning services remained low among all women, regardless of the type of prenatal care they received.
本研究旨在评估小组产前护理(GPNC)对产后计划生育利用的影响。
利用连续 12 个月参加医疗补助的女性回顾性队列(n=3637),检查参加 GPNC(n=570)和接受个体产前护理(IPNC;n=3067)的女性在产后计划生育服务利用方面的差异。采用倾向评分方法得出一个匹配队列,以进一步分析选定的结果。
在产后 4 个时间点,参与 GPNC 的女性比接受 IPCN 的女性更有可能利用产后计划生育服务:3 个月(7.72%比 5.15%,P<.05)、6 个月(22.98%比 15.10%,P<.05)、9 个月(27.02%比 18.42%,P<.05)和 12 个月(29.30%比 20.38%,P<.05)。在每个间隔内,非西班牙裔黑人女性的产后计划生育就诊率最高,在 12 个月时达到 31.84%的峰值。在倾向评分匹配后,GPNC 与产后计划生育服务利用之间的正相关关系在 6 个月(优势比[OR],1.42;95%置信区间[CI],1.05-1.92)、9 个月(OR,1.43;95%CI,1.08-1.90)和 12 个月(OR,1.44;95%CI,1.10-1.90)时仍然一致。
这些发现表明,GPNC 有可能对女性妊娠后健康结果产生积极影响,并提高预防保健服务的利用率。非西班牙裔黑人女性的产后计划生育服务利用率最高,进一步证明了 GPNC 在减少健康差距方面的影响。然而,尽管连续参加医疗补助,所有女性的产后计划生育服务利用率仍然很低,而不论她们接受的产前护理类型如何。