title: Women's Use of Health Care in the First 2 Years Postpartum: Occurrence and Correlates.
abstract: Objectives We sought to determine rates and correlates of accessing health care in the 2 years following delivery among women at an urban academic medical center. Methods We used electronic medical records, discharge, and billing data to determine the occurrence of primary care, other non-primary outpatient care, emergency department visits, and inpatient admissions among women delivering at a single medical center who had a known primary care affiliation to that medical center over a 5 year period. We explored sociodemographic, clinical, and health care-related factors as correlates of care, using bivariate and multivariable modeling. Results Of 6216 women studied, most (91 %) had had at least one health care visit in the window between 2 months and 2 years postpartum (the "late postpartum period"). The majority (81 %) had had a primary care visit. Factors associated with use of health care in this period included a chronic medical condition diagnosed prior to pregnancy (adjusted odds ratio (AOR) 1.42, 95 % CI [1.19, 1.71]), prenatal care received in an urban community health center (AOR 1.35 [1.06, 1.73]), having received obstetric (AOR 1.90 [1.51, 2.37]), primary (AOR 2.30 [1.68, 3.23]), or other non-primary outpatient care (AOR 2.35 [1.72, 3.39]) in the first 2 months postpartum, and living closer to the hospital [AOR for residence >17.8 miles from the medical center (AOR 0.74 [0.61, 0.90])]. Having had an obstetrical complication did not increase the likelihood of receipt of care during this window. Conclusions for Practice Among women already enrolled in a primary care practice at our medical center, health care utilization in the late postpartum period is high, but not universal. Understanding the characteristics of women who return for health care during this window, and where they are seen, can improve transitions of care across the life course and can provide opportunities for important and consistent interconception and well-woman messaging.
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. abryant@partners.org.
authors: Allison
authors: A
authors: Bryant
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors: Tiffany
authors: T
authors: Blake-Lamb
authors: Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
authors: Ida
authors: I
authors: Hatoum
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.|Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
authors: Milton
authors: M
authors: Kotelchuck
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008404:Massachusetts; D011181:Postnatal Care / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Disparities; Interconception care; Late postpartum care; Life course; Postpartum care