Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic
Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic
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DOI：
10.1007/s10995-019-02768-7
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发表时间：
2019-11-01
影响因子：
2.3
通讯作者：
Wilkins-Haug, Louise E.
中科院分区：
文献类型：
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作者：
Celi, Ann C.;Seely, Ellen W.;Wilkins-Haug, Louise E.
目的 我们开发了产后过渡诊所，以更好地支持妊娠高血压后的女性。描述 我们的计划目标是 (1) 早期产后高血压医疗管理，(2) 围绕 CVD 风险对患者和提供者进行教育，(3) 向初级保健提供者 (PCP) 过渡，以及 (4) 由私人和公共保险报销的可持续临床模式。在本次分析中，我们重点关注产后的女性。评估 在 5 年的时间里，412 名产后妇女在种族和社会经济上多样化，接受了一次、两次或多次预约的护理。转诊诊断包括产前子痫前期 (PET) 51% (210/412)、产后子痫前期/高血压 (PP-PET) 22.3% (92/412)、子痫前期合并慢性高血压 (siPET) 10.2% (42/412)、慢性高血压 (cHTN) 8.8% (37/412) 和妊娠期高血压(gHTN) 7.8% (31/412)。几乎一半的女性进行了 2-3 次就诊，占 47.3% (195/412)，诊断结果没有差异 (p = 0.18)。缺席率始终保持在 25% 左右。 5 年间，家用血压计的购买率从 56.8% (44/94) 增加到 93.8% (61/65) (p < 0.0001)。近一半的患者进行了抗高血压药物调整，占 48.3% (199/412)。在安排的患者中，86.8% (79/91) 参加了营养咨询。对于我们系统内有 PCP 的患者，79.5% (105/ 132) 保留了预定的 PCP 随访预约。结论 我们报告了妊娠高血压后的产后过渡诊所。在这个多元化的人群中，患者进行了 2-3 次就诊，纳入了家庭血压监测、调整抗高血压药物并启动了营养转诊和 PCP 随访等预防措施。内科医生的工资是通过私人和公共保险的账单和收款来维持的。
Purpose We developed a postpartum transition clinic to better support women after hypertensive pregnancy. Description Our program goals were (1) early postpartum hypertension medical management, (2) patient and provider education around CVD risk, (3) transition to primary care provider (PCP) and (4) a sustainable clinical model reimbursed by private and public insurances. We focused on women immediately postpartum in this analysis. Assessment Over the course of 5 years, a racially and socioeconomically diverse population of 412 immediately postpartum women received care for one, two or more appointments. Referral diagnoses included antepartum preeclampsia (PET) 51% (210/412), postpartum preeclampsia/hypertension (PP-PET) 22.3% (92/412), preeclampsia superimposed on chronic hypertension (siPET) 10.2% (42/412), chronic hypertension (cHTN) 8.8% (37/412), and gestational hypertension (gHTN) 7.8% (31/412). Almost half of women had 2-3 visits 47.3% (195/412) with no difference by diagnosis (p = 0.18). No show rates were consistently around 25%. Acquisition of home blood pressure monitors increased from 56.8% (44/94) to 93.8% (61/65) over the 5 years (p < 0.0001). Nearly half of patients seen had antihypertensive medication adjustments 48.3% (199/412). Of those patients scheduled, 86.8% (79/91) attended a nutrition consultation. For patients with PCPs within our system, 79.5% ( 105/ 132) kept their scheduled follow up PCP appointments. Conclusion We report a postpartum transition clinic after hypertensive pregnancy. In this diverse population, patients attended 2-3 visits, incorporated home blood pressure monitoring, adjusted antihypertensive medications and initiated prevention measures such as nutrition referrals and PCP follow-up. An internist salary was sustained through billings and collections from private and public insurance.