(220) Telehealth use and patient care utilization within one year postpartum

Objective: Telehealth is now widely used in obstetrics. Our objective was to examine the relationship between exclusive telehealth vs. in-person postpartum visits and healthcare utilization within the first year postpartum.

Study Design: We performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 7/1/2020–6/30/2021. The primary exposure was exclusive use of telehealth vs. in-person visit for postpartum care. Primary outcomes were use of long-acting reversible contraception (LARC) and pap smear screening within 1 year postpartum, services that require an in-person visit and can be provided outside of routine obstetric care (i.e., by a primary care provider). Secondary outcomes included weight assessment, prescription contraception use, primary care visits, and pregnancy within 1 year postpartum. Logistic regressions were performed to assess the association between the outcomes and telehealth vs. in-person postpartum care.

Results: Of the 3,407 individuals who delivered, 3,096 (90.9%) had a postpartum visit; 1,304 (33.4%) utilized telehealth exclusively. Those who used telehealth exclusively were more likely to self-identify as White (69.2 vs. 61.4%, p< 0.001), report English as their primary language (93.3 vs. 87.9%, p< 0.001), and not have pregnancy-related hypertension (13.8 vs. 18.5%, p< 0.001), gestational diabetes (6.7 vs. 11.3%, p< 0.001), and mental health conditions (15.9 vs. 18.8%, p=0.03). The telehealth users were less likely to have a pap smear (22.5 vs. 47.0%, p< 0.001) or use LARCs (8.7 vs. 21.9%, p< 0.001) than those receiving in-person care. There were reduced odds of all services in the telehealth compared to the in-person cohort, except subsequent pregnancy within 1 year (Table).

Conclusion: There was lower utilization of commonly recommended services within the first year postpartum for individuals who utilize telehealth services for postpartum care. As telehealth has become for patients to access medical care, these findings should prompt clinicians to consider what services may be delayed or missed by the exclusive use of telehealth.