Online Program

Barriers to prenatal care among women presenting to the emergency department

Tuesday, November 5, 2013

Priya Mammen, MD, MPH, Department of Emergency Medicine, Sidney Kimmel Medical College/ Thomas Jefferson University Hospital, Philadelphia, PA
Paul Dominici, MD, Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA
Nina Joyce, Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, MA
Early and adequate prenatal care (PNC) has an established association with a reduction in poor birth outcomes. While increased Medicaid funding has expanded access, barriers to PNC still exist. This study serves to determine characteristics of pregnant women presenting to the Emergency Department (ED) and to identify some barriers to their initiating PNC. Methods:A single round, cross sectional survey was administered to all pregnant women presenting to the ED at an urban tertiary care center during a three month period. Data was analyzed using t-tests and logistic regression models. Results:A total of 201 pregnant women were enrolled; 80% presented with known pregnancy status, while 20% were diagnosed in the ED. Of women with a known pregnancy, 47.5% had initiated PNC, although 81.8% believed PNC was very important. The most common cited reasons for lack of PNC initiation was inability to schedule an appointment when desired (31.0%), lack of insurance(11.9%), and personal reasons (16.7%) such as not having time. After learning they were pregnant, 38.9% of the subjects sought care in an ED, compared to 22.3% at OB-Gyn, 15.3% at health center, and 7.6% at PCP. Reported ED utilization increased from 20.9% before known pregnancy status to 38.9% after (p=0.003). Logistic regression shows positive correlations to initiating PNC with having a PCP (p=0.03), greater duration of pregnancy(p<0.005),and higher level of education (p=0.003). Conclusion:The ED provides a unique opportunity to approach those women most at risk of inadequate prenatal care and could allow intervention and patient education by health care providers.

Learning Areas:

Clinical medicine applied in public health
Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify barriers to appropriate prenatal care among pregnant women who present to the Emergency Department for medical treatment

Keyword(s): Maternal Care, Barriers to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a practicing Emergency Physician with specific interests in barriers to health services. I was the principal investigator of this study and have experience with research methodology as reflected in several other successful research endeavors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.