Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
NewYork-Presbyterian Hospital, New York, New York, USA.
Breastfeed Med. 2023 May;18(5):362-369. doi: 10.1089/bfm.2022.0264. Epub 2023 Apr 18.
Patients from low-income, minoritized communities have limited access to outpatient breastfeeding support with International Board Certified Lactation Consultants (IBCLCs). Telelactation may increase access particularly when appointments can be self-scheduled. To describe a medical center-based, outpatient breastfeeding support program that includes telelactation and serves a diverse patient population. A retrospective electronic chart review was performed for patients with in-person or telelactation visit types between April 2020 and December 2021. Impact of demographics (language, race/ethnicity, insurance) on scheduling patterns (self-scheduled versus traditionally scheduled), visit reasons, and impact of initial visit type and reason on subsequent follow-ups were determined. Feeding practice-to-feeding goal ratios were compared between initial and last visit to determine if breastfeeding goals were met. Descriptive statistics, linear regression, chi-square, and paired -tests were performed. Two thousand twenty-three patients (37.9% Spanish-speakers, 76.6% Latinx; 8.0% black/non-Latinx, 79.0% publicly insured) made 2,791 visits, of which 50.6% were for telelactation. Self-scheduling resulted in decreased no show rates (25.3% versus 42.8%, < 0.001). Commercially insured patients had greater odds of self-scheduling versus publicly insured (adjusted odds ratio: 9.22; 95% confidence interval, CI [6.27-13.57]) with no impact of race/ethnicity or language. Reasons for visit differed slightly by initial visit type. Practice-to-feeding goal ratios increased regardless of initial visit type: telelactation visit (0.84 to 0.88 [difference 0.04; 95% CI: 0.006-0.066; = 0.017]); and in-person visit (0.77 to 0.84 [difference 0.07; 95% CI: 0.044-0.11 < 0.001]). Telelactation as part of a medical center-based outpatient breastfeeding support program is a promising modality for both initial and follow-up visits. Self-scheduling decreased no show rates.
低收入、少数族裔社区的患者获得国际认证哺乳顾问（IBCLC）的门诊母乳喂养支持的机会有限。远程哺乳可能会增加这种机会，尤其是当预约可以自行安排时。本文描述了一种以医疗中心为基础的门诊母乳喂养支持项目，包括远程哺乳，并为不同的患者群体提供服务。对 2020 年 4 月至 2021 年 12 月期间有门诊或远程哺乳就诊类型的患者进行了回顾性电子病历审查。确定人口统计学因素（语言、种族/族裔、保险）对预约模式（自行预约与传统预约）、就诊原因以及初始就诊类型和原因对后续就诊的影响。比较初始就诊和最后一次就诊的喂养实践到喂养目标的比值，以确定母乳喂养目标是否达到。采用描述性统计、线性回归、卡方检验和配对 t 检验。共有 2023 名患者（37.9%讲西班牙语，76.6%拉丁裔；8.0%黑人/非拉丁裔，79.0%公共保险）进行了 2791 次就诊，其中 50.6%为远程哺乳。自行预约可降低失约率（25.3%比 42.8%， < 0.001）。与公共保险相比，商业保险患者更有可能自行预约（调整后的优势比：9.22；95%置信区间，CI [6.27-13.57]），种族/族裔或语言没有影响。就诊原因因初始就诊类型略有不同。无论初始就诊类型如何，实践到喂养目标的比值都有所增加：远程哺乳就诊（0.84 至 0.88[差值 0.04；95%置信区间：0.006-0.066； = 0.017]）和门诊就诊（0.77 至 0.84[差值 0.07；95%置信区间：0.044-0.11 < 0.001]）。远程哺乳作为医疗中心为基础的门诊母乳喂养支持项目的一部分，是初始和后续就诊的一种很有前途的模式。自行预约降低了失约率。
