The impact on postpartum care by telehealth: a retrospective cohort study

Abstract

Background: During the COVID-19 pandemic, our institution turned to telehealth as the primary method of postpartum care delivery.

Objective: We aimed to determine the impact of telehealth on completion of postpartum care goals.

Study design: In a single-center retrospective cohort study, we compared a 14-week period, March to June 2019, before implementation of telehealth, with the same calendar months after implementation during 2020. Patients with a postpartum visit scheduled at our institution during the study period were included. To demonstrate a 10% difference in attendance to the postpartum visit in the postimplementation compared with the preimplementation group, a power analysis calculation resulted in a requirement of at least 356 subjects per group. Our primary outcome was attendance to the postpartum visit. Secondary outcomes included completion of postpartum depression screening, contraception selection, breastfeeding status at postpartum visit, completion of 2-hour glucose tolerance test postpartum for those with gestational diabetes mellitus, and cardiology follow-up when recommended. Multivariable logistic regression with backward elimination was used to control for confounders.

Results: Of the 1579 patients meeting inclusion criteria, 780 were in the preimplementation group and 799 in the postimplementation group. Subjects in the postimplementation group were at 90% increased odds of attending a postpartum visit compared with those in the preimplementation group, even when controlling for race, prenatal care provider, parity, gestational age at delivery, and insurance status (82.9% vs 72.4%; P<.001; adjusted odds ratio, 1.90; 95% confidence interval, 1.47-2.46). Patients in the postimplementation group were also more likely to be screened for postpartum depression (86.3% vs 65.1%; P<.001). Although subjects in both groups were equally likely to choose contraception, those in the postimplementation group were less likely to select long-acting reversible contraception or permanent sterilization (26.2% vs 33.2%; P=.03). There was no significant difference in breastfeeding status, postpartum 2-hour glucose tolerance test completion, or cardiology follow-up between groups.

Conclusion: Availability of telehealth during the COVID-19 pandemic is associated with increased postpartum visit attendance and postpartum depression screening. However, telehealth was also associated with a decrease in use of long-acting reversible contraception or permanent sterilization.

Keywords: COVID-19; long-acting reversible contraception; obstetrical care; postpartum depression screening; postpartum visit attendance; telemedicine.