1
|
Kominiarek MA, Summerlin S, Martinez NG, Yee LM. Postpartum Patient Navigation and Postpartum Weight Retention. AJP Rep 2019; 9:e292-e297. [PMID: 31511799 PMCID: PMC6736666 DOI: 10.1055/s-0039-1694700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022] Open
Abstract
Objective This study aimed to evaluate postpartum weight retention (PPWR) among women who participated in a postpartum patient navigation (PN) program. Study Design English-speaking pregnant or postpartum women receiving publicly-funded prenatal care at a hospital-based clinic were invited to receive PN services through 12 weeks postpartum. Women were eligible for this analysis if height and weight values were available. Weights at 4 to 12 weeks and up to 12 months postpartum were compared in PN and non-PN historical-control groups and analyzed as mean PPWR (difference from prepregnancy weight) and categorically as PPWR > 5kg. Results Among the 311 women, 152 participated in the PN program and 159 were historical controls. There were no differences in age, race and ethnicity, prepregnancy body mass index (BMI), nulliparity, and preterm birth between the groups ( p > 0.05). At 4 to 12 weeks postpartum, mean PPWR (4.0 ± 6.7 vs. 2.7 ± 6.3 kg, p = 0.06) and PPWR > 5 kg (61/144 [42%] vs. 50/145 [34%], p = 0.15) did not differ between groups. Similarly, up to 12 months postpartum, mean PPWR (4.5 ± 7.1 vs. 5.0 ± 7.5 kg, p = 0.59) and PPWR > 5 kg (22/50 [44%] vs. 30/57 [53%], p = 0.55) did not differ between groups. Conclusion Although PN is a promising intervention to improve women's health care utilization and other associated health outcomes, in this particular navigation program, participation was not associated with PPWR at 4 to 12 weeks and up to 12 months postpartum.
Collapse
Affiliation(s)
- Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois
| | - Sydney Summerlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois
| | - Noelle G Martinez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology of Northwestern University, Chicago, Illinois
| |
Collapse
|
2
|
Bryant-Stephens T, Kenyon C, Apter AJ, Wolk C, Williams YS, Localio R, Toussaint K, Hui A, West C, Stewart Y, McGinnis S, Gutierrez M, Beidas R. Creating a community-based comprehensive intervention to improve asthma control in a low-income, low-resourced community. J Asthma 2019; 57:820-828. [PMID: 31082287 DOI: 10.1080/02770903.2019.1619083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting.Objective: Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia.Methods: September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps.Results: Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school.Conclusion: Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.
Collapse
Affiliation(s)
- Tyra Bryant-Stephens
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - C Kenyon
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - A J Apter
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - Courtney Wolk
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA.,Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Yolanda S Williams
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - R Localio
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - K Toussaint
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - A Hui
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - C West
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | | | - S McGinnis
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - M Gutierrez
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - R Beidas
- Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, PA, USA
| |
Collapse
|