Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst.
University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst.
JAMA Netw Open. 2020 Nov 2;3(11):e2025095. doi: 10.1001/jamanetworkopen.2020.25095.
Improving care during the postpartum period is a clinical and policy priority. During the comprehensive postpartum visit, guidelines recommend delivery of a large number of assessment, screening, and counseling services. However, little is known about services provided during these visits.
To examine rates of recommended services during the comprehensive postpartum visits and differences by insurance type.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 20 071 093 weighted office-based postpartum visits (645 observations) with obstetrical-gynecological or family medicine physicians from annual National Ambulatory Medical Care Surveys from December 28, 2008, to December 31, 2016, and estimated multivariate regression models to calculate the frequency of recommended services by insurance type, controlling for visit, patient, and physician characteristics. Data analysis was conducted from November 1, 2019, to September 1, 2020.
Visit paid by Medicaid vs other payment types.
Visit length and binary indicators of blood pressure measurement, depression screening, contraceptive counseling or provision, pelvic examinations, Papanicolaou tests, breast examinations, medication ordered or provided, referral to other physician, and counseling for weight reduction, exercise, stress management, diet and/or nutrition, and tobacco use.
A total of 20 071 093 weighted comprehensive postpartum visits to office-based family medicine or obstetrical-gynecological physicians were included (mean patient age, 29.7 [95% CI, 29.1-30.3] years). Of these visits, 34.3% (95% CI, 27.6%-41.1%) were covered by Medicaid. Mean visit length was 17.4 (95% CI, 16.4-18.5) minutes. The most common procedures were blood pressure measurement (91.1% [95% CI, 88.0%-94.2%]), pelvic examinations (47.3% [95% CI, 40.8%-53.7%]), and contraception counseling or provision (43.8% [95% CI, 38.2%-49.3%]). Screening for depression (8.7% [95% CI, 4.1%-12.2%]) was less common. When controlling for visit, patient, and physician characteristics, the only significant difference in visit length or provision of recommended services based on insurance type was a difference in provision of breast examinations (14.7% [95% CI, 8.0%-21.5%] for Medicaid vs 25.6% [95% CI, 19.4%-31.8%] for non-Medicaid; P = .02).
These findings suggest that receipt of recommended services during comprehensive postpartum visits is less than 50% for most services and is similar across insurance types. These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period.
改善产后期间的护理是临床和政策上的重点。在全面的产后访视中，指南建议提供大量评估、筛查和咨询服务。然而，对于这些访视中提供的服务知之甚少。
检查综合产后访视中推荐服务的比率，并按保险类型的差异进行检查。
设计、地点和参与者：这是一项横断面研究，纳入了 20071093 次有妇产科或家庭医学医生参与的加权门诊产后访视（645 次观察），这些访视来自于 2008 年 12 月 28 日至 2016 年 12 月 31 日的年度全国门诊医疗保健调查，并使用多变量回归模型来计算按保险类型计算推荐服务的频率，控制访视、患者和医生特征。数据分析于 2019 年 11 月 1 日至 2020 年 9 月 1 日进行。
由医疗补助支付的访视与其他支付类型的访视。
访视时间和血压测量、抑郁筛查、避孕咨询或提供、盆腔检查、巴氏试验、乳房检查、开处方或提供药物、转介给其他医生以及体重减轻、运动、压力管理、饮食和/或营养、吸烟使用的二进制指标。
共纳入了 20071093 次有家庭医学或妇产科医生参与的加权综合产后门诊访视（患者平均年龄为 29.7[95%CI，29.1-30.3]岁）。这些访视中，有 34.3%（95%CI，27.6%-41.1%）由医疗补助支付。平均访视时间为 17.4 分钟（95%CI，16.4-18.5）。最常见的程序是血压测量（91.1%[95%CI，88.0%-94.2%]）、盆腔检查（47.3%[95%CI，40.8%-53.7%]）和避孕咨询或提供（43.8%[95%CI，38.2%-49.3%]）。抑郁筛查（8.7%[95%CI，4.1%-12.2%]）则不太常见。在控制访视、患者和医生特征的情况下，基于保险类型，唯一在访视时间或推荐服务提供方面有显著差异的是乳房检查的提供（医疗补助为 14.7%[95%CI，8.0%-21.5%]，非医疗补助为 25.6%[95%CI，19.4%-31.8%]；P=0.02）。
这些发现表明，大多数服务的推荐服务接受率均低于 50%，且在不同保险类型之间相似。这些发现强调了重新概念化产后护理的重要性，以确保妇女在这个敏感时期能够获得一系列支持来管理自己的健康。
