Telehealth use and receipt of recommended services within one-year postpartum

Abstract

Introduction

In obstetrics, telehealth is widely used in the provision of prenatal and postpartum care. The objective was to compare the utilization of commonly recommended services after delivery among individuals receiving telehealth versus in-person postpartum care.

Study Design

We performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 1 July 2020 and 30 June 2023. The primary exposure was the exclusive use of telehealth versus an in-person visit for postpartum care. Two primary outcomes were assessed between 0 and 365 days after the delivery: 1) long-acting reversible contraceptive (LARC) method use and 2) pap smear screening. Secondary outcomes occurring between 0 and 365 days after delivery included: clinic-based weight assessment, clinic-based blood pressure assessment, any prescription contraception use, primary care visit, and pregnancy within 1 year.

Results

Among the 9953 individuals, 9058 (91.0%) had a postpartum visit. 1811 (19.9%) utilized telehealth exclusively, which peaked during the COVID-19 pandemic. Exclusive telehealth users were less likely to have a pap smear (21.6 vs. 40.1%, p < 0.001) or use LARCs (8.6 vs. 19.4%, p < 0.001) than those receiving in-person care. In the adjusted analysis, the odds ratio for receiving a pap smear was 0.38 (95% confidence interval [CI] 0.32–0.47) and for using a LARC was 0.38 (95% CI 0.31–0.47) when comparing telehealth to in-person care. Reduced odds of all secondary outcomes were seen in the exclusive telehealth use compared to the in-person cohort, with the exception of subsequent pregnancy within 1 year, which was not significantly different.

Discussion

Acknowledging that telehealth now has become an important means for patients to access medical care, these findings should prompt clinicians to consider when an in-person postpartum visit should be offered or recommended over telehealth, especially when a patient may not have a preference or reported barriers to accessing an in-person visit.