Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA..
Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2022 May;4(3):100611. doi: 10.1016/j.ajogmf.2022.100611. Epub 2022 Mar 22.
During the COVID-19 pandemic, our institution turned to telehealth as the primary method of postpartum care delivery.
We aimed to determine the impact of telehealth on completion of postpartum care goals.
In a single-center retrospective cohort study, we compared a 14-week period, March to June 2019, before implementation of telehealth, with the same calendar months after implementation during 2020. Patients with a postpartum visit scheduled at our institution during the study period were included. To demonstrate a 10% difference in attendance to the postpartum visit in the postimplementation compared with the preimplementation group, a power analysis calculation resulted in a requirement of at least 356 subjects per group. Our primary outcome was attendance to the postpartum visit. Secondary outcomes included completion of postpartum depression screening, contraception selection, breastfeeding status at postpartum visit, completion of 2-hour glucose tolerance test postpartum for those with gestational diabetes mellitus, and cardiology follow-up when recommended. Multivariable logistic regression with backward elimination was used to control for confounders.
Of the 1579 patients meeting inclusion criteria, 780 were in the preimplementation group and 799 in the postimplementation group. Subjects in the postimplementation group were at 90% increased odds of attending a postpartum visit compared with those in the preimplementation group, even when controlling for race, prenatal care provider, parity, gestational age at delivery, and insurance status (82.9% vs 72.4%; P<.001; adjusted odds ratio, 1.90; 95% confidence interval, 1.47-2.46). Patients in the postimplementation group were also more likely to be screened for postpartum depression (86.3% vs 65.1%; P<.001). Although subjects in both groups were equally likely to choose contraception, those in the postimplementation group were less likely to select long-acting reversible contraception or permanent sterilization (26.2% vs 33.2%; P=.03). There was no significant difference in breastfeeding status, postpartum 2-hour glucose tolerance test completion, or cardiology follow-up between groups.
Availability of telehealth during the COVID-19 pandemic is associated with increased postpartum visit attendance and postpartum depression screening. However, telehealth was also associated with a decrease in use of long-acting reversible contraception or permanent sterilization.
在 COVID-19 大流行期间，我们机构将远程医疗作为产后护理的主要方法。
我们旨在确定远程医疗对完成产后护理目标的影响。
在一项单中心回顾性队列研究中，我们比较了在实施远程医疗之前的 2019 年 3 月至 6 月的 14 周期间，与 2020 年同期相同的日历月。在研究期间，我们将在我们机构进行产后访视的患者纳入研究。为了证明在实施后组与实施前组相比，产后访视的出席率有 10%的差异，通过功率分析计算，每组需要至少 356 名受试者。我们的主要结局是出席产后访视。次要结局包括完成产后抑郁症筛查、选择避孕措施、产后访视时的母乳喂养状况、对患有妊娠期糖尿病的患者进行产后 2 小时葡萄糖耐量试验，以及推荐时进行心脏科随访。采用向后消除的多变量逻辑回归来控制混杂因素。
在符合纳入标准的 1579 名患者中，有 780 名在实施前组，799 名在实施后组。与实施前组相比，实施后组的患者参加产后访视的可能性增加了 90%，即使在控制种族、产前护理提供者、产次、分娩时的孕龄和保险状况后也是如此（82.9%对 72.4%；P<.001；调整后的优势比，1.90；95%置信区间，1.47-2.46）。实施后组的患者也更有可能接受产后抑郁症筛查（86.3%对 65.1%；P<.001）。尽管两组患者选择避孕措施的可能性相同，但实施后组选择长效可逆避孕措施或永久性绝育的可能性较低（26.2%对 33.2%；P=.03）。两组在母乳喂养状况、产后 2 小时葡萄糖耐量试验完成情况或心脏科随访方面无显著差异。
在 COVID-19 大流行期间提供远程医疗与增加产后访视出席率和产后抑郁症筛查有关。然而，远程医疗也与长效可逆避孕措施或永久性绝育的使用减少有关。
