Patient perspectives on prenatal care delivery innovation: a call to action from pregnant high and low utilizers of unscheduled care
Akpovi, Eloho Ejiro Fidelia
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BACKGROUND: Rising rates of maternal morbidity and mortality and persistent disparities in care utilization and outcomes signal a need for new approaches to prenatal care delivery. This study uses perspectives of low-socioeconomic status (SES) pregnant women to generate features of a patient-centered intervention aimed at improving outcomes in high cost, high need pregnant individuals. METHODS: We performed a secondary analysis of qualitative interviews with Medicaid-insured pregnant high and low utilizers of unscheduled obstetric care. Using a grounded theory approach, we tightly mapped themes to generate intervention strategies with potential to improve prenatal care delivery. RESULTS: Three key themes translated into intervention features: social support, care delivery, and access. Unlike low utilizers, high utilizers had a desire for more social support, improved communication in care delivery, and access to timely and efficient appointments. For low utilizers, improved insurance access and the ability to opt out of support services that didn’t align with their priorities were essential. CONCLUSION: High and low utilizers of unscheduled obstetric care have unique ideas for improving their care. Targeted interventions to improve prenatal care can be tested to potentially address unmet needs of vulnerable subgroups of low-SES pregnant women at risk for poor outcomes.