Telehealth may reduce racial disparities in postpartum visit attendance

Availability of telehealth significantly reduced disparities in postpartum visit attendance between Black and non-Black patients, researchers reported in the American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine.

The United States has one of the highest rates of pregnancy-related death among high-income countries and has great racial disparities. There were 40.8 pregnancy-related deaths per 100,000 live births among non-Hispanic Black women between 2007 and 2016 and only 12.7 pregnancy-related deaths per 100,000 live births among non-Hispanic white women, according to study background.

“Prior to the COVID-19 pandemic, limited data demonstrated that perinatal telemedicine can provide health outcomes comparable with in-person care for diabetes, hypertension and perinatal depression,” Natasha R. Kumar, MD, a maternal-fetal medicine fellow at Penn Medicine in Philadelphia, and colleagues wrote. “However, it remains unclear whether telehealth models will address disparities in perinatal care, as feasibility of these services can be limited by access to technology and availability of child care support.”

Kumar and colleagues retrospectively reviewed data from the electronic medical records of patients who had scheduled a postpartum visit at an outpatient obstetric clinic associated with their tertiary care center between 21 and 56 days postpartum. The researchers did this for all patients scheduled between March 16 and June 16, 2019, and for those scheduled during the same months in 2020 following the implementation of telehealth.

The primary outcome was postpartum visit attendance. Secondarily, the researchers assessed postpartum depression screening, contraception selection, feeding plan and follow-up visit completion for patients with gestational diabetes, cervical dysplasia or severe preeclampsia.

In total, 780 patients were scheduled for visits in the pre-implementation period, and 799 were scheduled in the post-implementation period. During the post-implementation period, 317 patients had audio visits, 174 had video visits and 156 had in-person visits. Most (n = 996; 63%) patients were Black, with 26% of patients identifying as white and 1% identifying as “Latinx,” according to the researchers.

Before the implementation of telehealth, Black patients were less likely to attend a scheduled postpartum visit vs. non-Black patients (63.9% vs. 88.7%; adjusted OR = 0.48; 95% CI, 0.29-0.79). Once telehealth was implemented, there was no significant difference in visit attendance between Black and non-Black patients.

In adjusted analyses, Black patients were less likely to be screened for postpartum depression vs. non-Black patients during the pre-implementation period (aOR = 0.48; 95% CI, 0.29-0.8). After the implementation of telehealth, the difference was no longer significant.

Associations for other secondary outcomes were not significant in adjusted analyses for either period.

“Future studies examining the impact of telehealth implementation on health disparities should focus on patient experiences and quality of care for outcomes that ultimately required in-person care,” Kumar and colleagues wrote.