Telehealth Boosts Postpartum Visit Attendance Among Black Patients

Offering telehealth options for postpartum care helped cut racial disparities in visit attendance, according to a study.

Published in the February issue of the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine, the study aimed to assess the impact of telehealth implementation on racial disparities in postpartum care during the COVID-19 pandemic.

The US has one of the worst maternal care track records of any high-income country in the world. According to the Commonwealth Fund, the US maternal mortality rate in 2020 was more than three times higher than that of most high-income countries. Not only that, but the racial disparities in maternal care outcomes in the US are stark, with Black women more than 2.5 times as likely as White women to die during pregnancy or childbirth.  

Further, more than half of pregnancy-related deaths occur in the postpartum period, the study noted.

To determine whether telehealth could help close race-based gaps in postpartum visit attendance, researchers from Penn Medicine conducted a retrospective cohort study at a single tertiary care center. They compared data from March 16 to June 16, 2019, before telehealth options were implemented for postpartum care, to data from the same three-month period in 2020, after telehealth implementation.

Patients were included in the analysis if they had scheduled a postpartum visit between 21 and 56 days after delivery.

Of the 1,579 patients meeting the inclusion criteria, 780 had a postpartum visit scheduled prior to telehealth implementation, and 799 had one scheduled in the post-telehealth implementation period. Within the post-implementation group, 317 patients had audio-only visits, 174 had video visits, and 156 had in-person visits.

Further, 63 percent of patients self-identified as Black, 26 percent as White, and 1 percent as Latinx.

Researchers found that Black patients were less likely to attend a postpartum visit than non-Black patients before telehealth implementation, with 63.9 percent of Black patients attending these visits compared with 88.7 percent of their non-Black peers.

Following telehealth implementation, Black patients were still less likely than non-Black patients to attend a postpartum visit. But after controlling for insurance, education, parity, and scant prenatal care, there was no significant difference in postpartum visit attendance by race.

In addition, the study shows that before telehealth implementation, Black patients were significantly less likely to receive a postpartum depression screening, breastfeed their infants, and attend cardiology follow-up visits than non-Black patients. After implementation, there was no difference between the two groups with regard to receiving a postpartum depression screening or attending a cardiology follow-up visit. But Black patients were still less likely to breastfeed than non-Black patients.

"Our study shows that telehealth can help Black patients get more of the care they need after delivery such as postpartum depression screening, Pap smears, contraception, and follow-up care with cardiology when needed," said Rebecca Hamm, MD, the study's primary investigator and senior fellow at Penn's Leonard Davis Institute of Health Economics, in a Q&A blog post. "These health care services are important for long-term health."

These research findings align with previous studies showing telehealth's positive impact on maternal care.

A study published last July found that replacing or supplementing in-person maternal healthcare with telehealth led to positive clinical outcomes and high patient satisfaction. For the study, researchers reviewed prior research, including 28 randomized controlled trials and 14 observational studies.

They found that patient-reported outcomes from telehealth interventions were similar to, if not better, than those that resulted from in-person care. Further, they found that strategies such as phone-based psychotherapy and home monitoring devices led to reduced anxiety and depression and high satisfaction levels among women seeking maternal care.