Ambulatory care utilization in the first 24 months’ postpartum by rurality and pregnancy-related conditions: A prospective cohort study from Maine

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2024-12-25 DOI:10.1111/jrh.12912

Sydney M. Bebus RN, Kristin Palmsten ScD, Heather S. Lipkind MD, MS, Christina M. Ackerman-Banks MD, Katherine A. Ahrens MPH, PhD

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引用次数: 0

Abstract

Purpose

To estimate the rate of ambulatory care use among postpartum persons by rurality of residence and pregnancy-related conditions.

Methods

We used Maine Health Data Organization's All Payer Claims Data for persons who delivered between 2007 and 2019 (N = 121,905). We estimated rates of ambulatory care (nonemergency department outpatient health care) utilization during the first 24 months’ postpartum by level of rurality (urban, large rural, small rural, and isolated rural) and by pregnancy-related conditions (prenatal depression, hypertensive disorders of pregnancy, and gestational diabetes). To estimate rate ratios (RR), we used Poisson regression with an offset for population at risk, adjusting for potential confounders and restricting the analysis to those with continuous insurance (n = 70,431).

Findings

The mean monthly rate per 100 deliveries of ambulatory care visits was 86.1; the median number of visits was 12 (interquartile range = 6, 25). Persons living in rural areas had lower monthly rates of visits than persons living in urban areas (adjusted RR ranged from 0.87 [95% CI: 0.85, 0.89] in isolated rural areas to 0.91 [95% CI: 0.90, 0.93] in large rural areas). Persons with prenatal depression (aRR = 2.07; 95% CI: 2.04, 2.11), hypertensive disorders of pregnancy (aRR = 1.07; 95% CI: 1.05, 1.10), and gestational diabetes (aRR = 1.11; 95% CI: 1.08, 1.14) had higher rates of visits than those without these conditions.

Conclusions

New practices and policies may be needed to improve postpartum ambulatory care access and utilization in rural areas. Postpartum persons with pregnancy-related conditions are accessing ambulatory care at higher rates after delivery, which may reduce their need for acute health care use.

查看原文本刊更多论文

产后24个月的门诊护理利用与农村和妊娠相关疾病：来自缅因州的一项前瞻性队列研究

目的：根据居住农村和妊娠相关情况估计产后患者门诊护理使用率。方法：我们使用缅因州健康数据组织2007年至2019年期间分娩的所有付款人索赔数据（N = 121905）。我们根据农村水平（城市、大农村、小农村和偏远农村）和妊娠相关疾病（产前抑郁症、妊娠高血压疾病和妊娠糖尿病）估计了产后前24个月的门诊护理（非急诊门诊保健）使用率。为了估计比率（RR），我们使用了泊松回归，对风险人群进行了偏移，调整了潜在的混杂因素，并将分析限制在连续保险的人群中（n = 70,431）。结果：月平均每100次门诊就诊率为86.1次；就诊次数中位数为12次（四分位数间距= 6,25）。生活在农村地区的人每月就诊率低于生活在城市地区的人（调整后的RR范围从偏远农村地区的0.87 [95% CI: 0.85, 0.89]到广大农村地区的0.91 [95% CI: 0.90, 0.93]）。产前抑郁患者(aRR = 2.07；95% CI: 2.04, 2.11)，妊娠期高血压疾病(aRR = 1.07；95% CI: 1.05, 1.10)和妊娠期糖尿病(aRR = 1.11；95% CI: 1.08, 1.14)的患者就诊率高于无上述情况的患者。结论：提高农村地区产后门诊服务的可及性和利用率需要新的实践和政策。产后患有妊娠相关疾病的人在分娩后获得门诊护理的比例更高，这可能减少她们对紧急保健服务的需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.