Telehealth Uptake and Rural-Urban and Racial/Ethnic Disparities in Postpartum Care Access Among Medicaid Beneficiaries in South Carolina, 2018-2022.

Abstract

Background: Although telehealth is increasingly being used for providing postpartum care, its role in ensuring timely postpartum care initiation in racial/ethnic minorities and rural residents is unknown.

Objectives: To compare attendance and timeliness of postpartum care initiation by pandemic exposure and telehealth uptake across race/ethnicity and rural-urban residences.

Research design: Retrospective cohort study.

Subjects: Medicaid-insured individuals who gave birth in South Carolina between January 1, 2018, and September 30, 2022, were aged 15-49 years, and were followed up until December 31, 2022.

Measures: Cox proportional hazards models examined associations between pandemic exposures, telehealth uptake, and racial/ethnic and rural/urban disparities in postpartum care initiation timeliness.

Results: Median time to postpartum care initiation was 25 days [interquartile range (IQR): 14-41 d] with variations across race/ethnicity and residence. Fully-exposed nontelehealth users had slower initiation [adjusted hazard ratio (aHR): 0.95; 95% CI: 0.91-1.00], while telehealth users had quicker initiation (aHR: 2.19; 95% CI: 1.93-2.48) compared with non- or partially-exposed individuals. Among minimal- or no-telehealth users, postpartum care initiation was slower for Hispanic and non-Hispanic Black individuals compared with their non-Hispanic White peers. There were no differences in timely care initiation by race or residence among fully-exposed telehealth users.

Conclusions: Telehealth may improve racial/ethnic disparities in timely postpartum care initiation. Rural-urban disparities in initiating timely postpartum care still warrant further investigation.