Improving Access to Prenatal Care of High-Risk Pregnant Women in Houston, Texas: The Role of Nurse Driven Care Management.

Abstract

Background: Prenatal care in the US is often mediated through managed care organisations. Other community-based health organisations also implement nurse-led care programs to help pregnant women navigate prenatal care services. The aim of this study is to assess the impact of such organisational services.

Material and methods: This was a retrospective cohort analysis of data generated from providing community-based care management services to pregnant women in Houston, Texas. Clients' characteristics and outcomes were analysed and described.

Results: About 60 pregnant women received care management services between 2022 and 2023. Out of these, 24 (40%) were teenagers (13-19 years of age), 28 (47%) were young adults (20-26 years), 5 (8%) were 27-30 years, and 3 (5%) were older than 35 years. The youngest patient was 15 years old and the oldest was 39 years. 50% (n = 30) were African-American, 38% (n = 23) were Hispanic, and 12% (n = 7) were white. 48% (n = 29) were in their second trimester, 30% (n = 18) were in their first trimester and 22% (n = 13) were in their third trimester. The earliest gestational age was four weeks, the oldest gestational age was 38 weeks, and the average was 20 weeks. The most common medical risk factors were anxiety, depression, and epilepsy. Others included anaemia, diabetes, alcoholism, smoking, PCOS, thalassemia, renal disease, COVID-19 infection, Lupus erythematosus, multiple gestation, and previous miscarriage. Half of the women, n = 27 (46%), had incorrect Medicaid health insurance that did not cover pregnancy care, and the other half, n=32 (54%), had no health insurance at all.

Conclusion: While it took an average of 53 days for the women in this study to get enrolled in a managed care organisation, it only took an average of 22 days for them to attend their first doctor's appointment when care was directly coordinated by a nurse led community-based health organization. This speaks to the efficacy of nurse-led, community-based care management in improving early access to prenatal care.