Abuse psychosocial stress and high medical utilization in pregnancy l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 19

Abuse, Psychosocial Stress And High Medical Utilization In Pregnancy PowerPoint PPT Presentation

Abuse, Psychosocial Stress And High Medical Utilization In Pregnancy Tina Bloom, R.N, MPH Mary Ann Curry, RN, DNSc School of Nursing, Oregon Health & Science University A secondary analysis from “Randomized Nursing Intervention to Abused Pregnant Women” (2001-2005).

Related searches for Abuse, Psychosocial Stress And High Medical Utilization In Pregnancy

Download Presentation

Abuse, Psychosocial Stress And High Medical Utilization In Pregnancy

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Abuse psychosocial stress and high medical utilization in pregnancy l.jpg

Abuse, Psychosocial Stress And High Medical Utilization In Pregnancy

Tina Bloom, R.N, MPH

Mary Ann Curry, RN, DNSc

School of Nursing, Oregon Health & Science University


A secondary analysis from randomized nursing intervention to abused pregnant women 2001 2005 l.jpg

A secondary analysis from “Randomized Nursing Intervention to Abused Pregnant Women” (2001-2005).

RO1 NR02696, National Institutes of Nursing Research.

Dr. Mary Ann Curry, P.I.


General high utilization l.jpg

General High Utilization

  • ~Half of ED visits for non-urgent reasons

  • Most emergency department patients do not require hospitalization

  • “Serial users” account for many ED visits

(Cook et al, 2004; Mandelberg, Kuhn, & Kohn, 2000)


Characteristics of high utilizers in general literature l.jpg

Characteristics of High Utilizers in General Literature

  • Multiple complaints: sprains, superficial injuries, back problems, headaches, or abdominal pain

  • Chronically ill

  • Male or female


Characteristics of high utilizers in general literature5 l.jpg

Characteristics of High Utilizers in General Literature

  • Non-white

  • Stressed, isolated, mentally ill, ETOH abusers

  • Uninsured, underinsured, low income

  • Abuse, trauma (current or historical)

(Cook et al, 2004; Mandelberg, Kuhn, & Kohn, 2000)


Trauma and high utilization l.jpg

Trauma and High Utilization

  • Childhood trauma/sexual abuse history and IPV associated with physical and mental health sequelae, and

  • High utilization of medical services

  • IPV in pregnancy 0.9% to 20.2%

Hendricks-Matthews, 1992; Arnow, 2004; Arnow et al 2000; Campbell 2002; Farley & Patsalides, 2001; Katon, Sullivan, & Walker, 2001; Rosenberg et al., 2000; Stein et al., 2000, 2004;Katon et al., 2001; Gazmararian et al 2000.


Utilization in pregnancy l.jpg

Utilization in Pregnancy

Most utilization

literature focuses on

women with little or no

prenatal care, and/or

late entry to prenatal

care.


Research question l.jpg

Research Question:

Do psychosocial stressors (trauma, abuse) and social disadvantage (poverty, race, lack of resources) play a significant role in high medical utilization among pregnant women?


Randomized nursing intervention to abused pregnant women study l.jpg

“Randomized Nursing Intervention to Abused Pregnant Women” Study

A multi-site RCT to determine if a nurse-case management intervention have a significant impact on pregnancy outcomes, including medical utilization, for women at risk for or experiencing violence?

[Curry et al (2006). Nurse case management for pregnant women experiencing or at risk for abuse, JOGNN, 35, 181-192] .


Secondary analysis 500 pregnant women l.jpg

Secondary Analysis: 500 Pregnant Women

Members of a West Coast HMO.

  • 68% Caucasian

  • 16% African American

  • Latino 4%

  • Asian/Pacific Islander 4%

  • Native American/Alaskan Native 1%


Secondary analysis 500 pregnant women11 l.jpg

Secondary Analysis: 500 Pregnant Women

  • Mean age 29.72 (5.91)

  • Mean income $3871 (2889)

  • Mean education 15 yrs (2.86)

  • 68% married

  • 17% single, living with partner


High utilizers hu in this study l.jpg

High Utilizers (HU) in This Study

  • Women with 5 or more visits to the L&D, urgent care, ED, or nurse treatment (>2SD mean)

  • HU n=41; mean # of visits 7.78 (3.2)

  • LU n=328; mean # of visits 0.99 (1.1)


Recent abuse l.jpg

Recent Abuse

*=p<.05; **=p<.01; ***=p<.001


High utilizers differed significantly from low utilizers p 05 l.jpg

Uninsured or Oregon Health Plan

Non-white

Lower income

High school dropouts

Younger

Live alone

Higher stress & lower self-esteem

Recent abuse (used the AAS to screen)

High Utilizers Differed Significantly from Low Utilizers, p<.05


Diagnoses for high utilizers l.jpg

Diagnoses for High Utilizers

  • Preterm onset of contractions/PTL***

  • Hyperemesis***

  • Gestational Diabetes*

  • Weight disorders*

  • Neurological problems***

  • Musculoskeletal problems*

*=p<.05; **=p<.01; ***=p<.001


No significant differences l.jpg

Gravida/Parity

Previous complications

Onset of prenatal care

Maternal or infant hospital stay at delivery

Birth weight (145 g. difference--ns)

No Significant Differences:

…Gestational age at delivery did differ—by 4.4 days:

HU=38.48 weeks, SD 1.6

LU=39.12, SD 1.9,…. p<.05


Conclusion l.jpg

Conclusion

Pregnant women who used more medical services in our study were a vulnerable group characterized by past and current violence, economic disadvantage, & psychosocial stress.


Limitations l.jpg

Limitations

  • Broad categories for diagnoses and chief complaints

  • Small number of participants– esp. for HU

  • Did not measure emotional abuse or mental health symptoms in this study


Implications l.jpg

Implications

  • High utilizers are a vulnerable group that are more likely to be in need of social services, extra support— due to high stress, low self esteem, & abuse

  • We could have predicted high utilization @ T1 (weeks 16-23). This is a missed opportunity to provide needed services.

  • Need for more research. Urgent care clinic or hospital a refuge?


  • Login