Primary Care Visits by the Postpartum Women with Gestational Diabetes and Hypertension: Analysis of Medicaid Claims Data in South Carolina

Authors' Affiliations

Kajol Dahal, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Dr. Melissa White, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Dr. Nathan Hale, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN.

Location

Culp Center Rm. 217

Start Date

4-25-2023 3:20 PM

End Date

4-25-2023 3:40 PM

Faculty Sponsor’s Department

Health Services Management & Policy

Name of Project's Faculty Sponsor

Nathan Hale

Classification of First Author

Graduate Student-Doctoral

Competition Type

Competitive

Type

Oral Presentation

Project's Category

Womens Health

Abstract or Artist's Statement

Introduction: Gestational diabetes (GDM) affects one in three pregnancies and women with GDM have a 10-fold higher risk of developing type-2 diabetes during their lifetime. Similarly, hypertensive disorders (HPD) of pregnancy affect up to one in seven pregnancies and have a 4-fold increase in the risk of hypertension and a 2-fold risk of cardiovascular diseases (CVD) over the lifetime. Primary care (PC) transitions are critical for the management of GDM and HDP to reduce the long-term risk of developing type-2 diabetes, hypertension, and CVD. Despite clinical guidelines recommending PC follow-up for continuous and sustainable care practice, only 50% of postpartum mothers transition to PC within 12 months. Few studies examine this issue and none in South Carolina. Therefore, our study uses Medicaid Claims data to examine the extent to which postpartum mothers with GDM and HDP transition to PC within 12 months of childbirth. Methods: We examined cross-sectional data of Medicaid women with a live birth in the years 2017 and 2018 in South Carolina. Women above the age of 20, receiving postpartum services within 12 months of delivery were included in the study. Primary care visits was the outcome variable of interest. Any women with at least one primary care visit (Family/General Practice Physician visit) claim in the 12 months following birth were considered as a primary care transition. GDM, HDP, and both (GDM &HDP) were the primary independent variables of interest. Results: In 14,273 postpartum mothers, the prevalence of GDM, HDP, and both (GDM & HDP) were found to be 10.02%, 15.05%, and 3.60% respectively. Among the women with GDM, 47.02% had visited PC compared to 35.02% of women without GDM (p<0.001). Similarly, 48.12% of women with HDP visited PC compared to 34.23% of women without HDP (p<0.001). In addition, 52.66% of women with both (GDM & HDP) visited PC compared to 35.72% of women without both (GDM & HDP) (p<0.001). After adjusting for maternal age, ethnicity, residence, and pay category, women with GDM were 1.43 times more likely to visit PC as compared to the women with no GDM (95% CI: 1.27–1.61). Similarly, the odds of visiting PC by women with HDP was 1.67 times higher as compared to women without HDP (95% CI: 1.51 – 1.84). Conclusion: In this study, postpartum mothers with GDM and HDP had higher odds of PC visits compared with those without GDM and without HDP respectively. This is positive. However, the overall percentage of women visiting PC with chronic disease was lower than 50%. To change health outcomes among women with chronic diseases like GDM and HDP, lifelong screening and disease management are needed. It is necessary to link postpartum mothers with PC to improve illness management and raise screening adherence. However, more barriers preventing under-resourced women from receiving PC should be analyzed and addressed.

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Apr 25th, 3:20 PM Apr 25th, 3:40 PM

Primary Care Visits by the Postpartum Women with Gestational Diabetes and Hypertension: Analysis of Medicaid Claims Data in South Carolina

Culp Center Rm. 217

Introduction: Gestational diabetes (GDM) affects one in three pregnancies and women with GDM have a 10-fold higher risk of developing type-2 diabetes during their lifetime. Similarly, hypertensive disorders (HPD) of pregnancy affect up to one in seven pregnancies and have a 4-fold increase in the risk of hypertension and a 2-fold risk of cardiovascular diseases (CVD) over the lifetime. Primary care (PC) transitions are critical for the management of GDM and HDP to reduce the long-term risk of developing type-2 diabetes, hypertension, and CVD. Despite clinical guidelines recommending PC follow-up for continuous and sustainable care practice, only 50% of postpartum mothers transition to PC within 12 months. Few studies examine this issue and none in South Carolina. Therefore, our study uses Medicaid Claims data to examine the extent to which postpartum mothers with GDM and HDP transition to PC within 12 months of childbirth. Methods: We examined cross-sectional data of Medicaid women with a live birth in the years 2017 and 2018 in South Carolina. Women above the age of 20, receiving postpartum services within 12 months of delivery were included in the study. Primary care visits was the outcome variable of interest. Any women with at least one primary care visit (Family/General Practice Physician visit) claim in the 12 months following birth were considered as a primary care transition. GDM, HDP, and both (GDM &HDP) were the primary independent variables of interest. Results: In 14,273 postpartum mothers, the prevalence of GDM, HDP, and both (GDM & HDP) were found to be 10.02%, 15.05%, and 3.60% respectively. Among the women with GDM, 47.02% had visited PC compared to 35.02% of women without GDM (p<0.001). Similarly, 48.12% of women with HDP visited PC compared to 34.23% of women without HDP (p<0.001). In addition, 52.66% of women with both (GDM & HDP) visited PC compared to 35.72% of women without both (GDM & HDP) (p<0.001). After adjusting for maternal age, ethnicity, residence, and pay category, women with GDM were 1.43 times more likely to visit PC as compared to the women with no GDM (95% CI: 1.27–1.61). Similarly, the odds of visiting PC by women with HDP was 1.67 times higher as compared to women without HDP (95% CI: 1.51 – 1.84). Conclusion: In this study, postpartum mothers with GDM and HDP had higher odds of PC visits compared with those without GDM and without HDP respectively. This is positive. However, the overall percentage of women visiting PC with chronic disease was lower than 50%. To change health outcomes among women with chronic diseases like GDM and HDP, lifelong screening and disease management are needed. It is necessary to link postpartum mothers with PC to improve illness management and raise screening adherence. However, more barriers preventing under-resourced women from receiving PC should be analyzed and addressed.