A new study led by scholars in the School of Public Health and Health Sciences at the University of Massachusetts Amherst finds that most women are receiving fewer than half the services recommended during their comprehensive postpartum medical checkup.
The researchers analyzed data from the National Ambulatory Medical Care Survey, which represented more than 20 million postpartum office visits to an ob-gyn or family medicine doctor from 2009 to 2016. Recommended services include blood pressure screening; depression screening; pelvic exam; pap test; breast exam; blood glucose exam; contraceptive counseling or provision; counseling for weight reduction, exercise, stress management, diet/nutrition, and/or tobacco use; medication review; and referral to another physician, if needed.
The study calculated the percentage of visits during which the recommended postpartum care services were provided, including the following:
Blood pressure, 91.1%
Depression screening, 8.7%
Pelvic exam, 47.3%
Pap test, 15.9%
Breast exam, 21.9%
Contraceptive counseling or provision, 43.8%
The medical visits averaged about 17 minutes, the researchers found, which may help explain the incomplete postpartum care. In one of the most startling findings, despite an increased awareness of perinatal depression, only one in 11 patients received a screening for depression.
“We need to look at why depression screening is not happening,” said Laura Attanasio, an assistant professor of health policy and management at the University of Massachusetts and a co-author of the study. “This is an important factor in women’s health for the rest of their lives. Even if you’re missing some of the recommended services, this one should be universal among this population.”
“This research is very important because we were able to look at care that was actually provided and really understand what happened during health care visits, not just that the visits are happening. This information is critical for improving the quality of care,” says Kimberly Geissler, also an assistant professor of health policy and management at the university and a co-author of the study.
The full study, “Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits,” was published on JAMA Network Open. It may be accessed here.