Woodroof Kathryn Vollum, Chichester Melanie, Antell Karen, Wohler Diana
Department of OB/GYN, ChristianaCare Health System.
Director of Maternity and Women's Health Education, Family Medicine Residency, Faculty Physician, Obstetrics and Gynecology Residency, Christiana Care Health System.
Dela J Public Health. 2024 Dec 23;10(5):6-10. doi: 10.32481/djph.2024.12.03. eCollection 2024 Dec.
To investigate if a telehealth option as the initial postpartum visit would increase postpartum visit attendance.
This was a retrospective cohort study of women receiving prenatal care through a federally qualified health center, Westside Family Health in Delaware, comparing attendance at a postpartum visit before telehealth was an option (2018) versus after the onset of the pandemic (2021). Representative random samples were taken from one year of deliveries pre- and post-implementation of the telehealth visit option. The primary outcome of this study was attendance of any postpartum visit before and after the option of a telehealth visit.
A total of 700 subjects were enrolled, with 349 subjects pre-telehealth and 351 subjects post-telehealth implementation. Our population was >50% Hispanic/Latina and >40% Spanish- speaking. The post-implementation group had a significantly higher attendance of the postpartum visit (83.95% vs. 90.60%, p-value 0.0092, OR 1.887, 95% CI 1.171-3.043).
There was a significant increase in the rate of postpartum visit attendance with the addition of a telehealth visit option. Postpartum depression screening was negatively impacted by the introduction of the telehealth visit.
The recommendation for all women post-delivery is to see their obstetric provider within the first 3 weeks postpartum. This includes assessing for complications, postpartum wellness and interconception care planning before 12 weeks post-delivery. We found that there was a significant increase in the rate of postpartum visit attendance with the addition of a telehealth visit option. Telemedicine has increased dramatically with the COVID-19 pandemic, and patients are satisfied with telehealth as an option for care. Telemedicine offers the convenience of portable health care. However, those in underserved populations may or may not be able to access care through telemedicine, as telehealth requires reliable internet service, a smartphone or computer, and digital literacy. Lack of access to any of these may create health care disparities, especially in disadvantaged or vulnerable populations.
研究将远程医疗作为产后首次就诊的方式是否会提高产后就诊率。
这是一项对通过特拉华州西区家庭健康中心（一家联邦合格健康中心）接受产前护理的女性进行的回顾性队列研究，比较了在远程医疗成为一种选择之前（2018年）和大流行开始后（2021年）的产后就诊率。从远程医疗就诊选项实施前后的一年分娩病例中抽取代表性随机样本。本研究的主要结果是在有远程医疗就诊选项前后的任何产后就诊的就诊率。
共纳入700名受试者，其中远程医疗实施前349名，实施后351名。我们的研究对象中超过50%为西班牙裔/拉丁裔，超过40%说西班牙语。实施后组的产后就诊率显著更高（83.95%对90.60%，p值0.0092，OR 1.887，95%CI 1.171 - 3.043）。
增加远程医疗就诊选项后，产后就诊率显著提高。远程医疗就诊的引入对产后抑郁症筛查产生了负面影响。
建议所有产后女性在产后3周内就诊于产科医生。这包括在产后12周前评估并发症、产后健康状况和受孕间隔期护理计划。我们发现增加远程医疗就诊选项后，产后就诊率显著提高。随着新冠疫情，远程医疗大幅增加，患者对将远程医疗作为一种护理选择感到满意。远程医疗提供了便捷的移动医疗服务。然而，服务不足人群中的个体可能能够或无法通过远程医疗获得护理，因为远程医疗需要可靠的互联网服务、智能手机或电脑以及数字素养。缺乏这些条件中的任何一项都可能造成医疗保健差距，尤其是在弱势或易受伤害人群中。
