The population I chose to discuss was postpartum mothers developing postpartum depression. A common gap in healthcare in this population is how mothers are not seen in the OB office until their 6 week follow up appointment after birth. For some mothers, postpartum depression symptoms can already be beginning by then. There was a study conducted that had mothers set up both a 2 week and 6 week postpartum appointment. Results showed that although not everyone attended the 2 week appointment, with those that did, there were benefits to checking up the patient’s mood earlier (Pluym, et al., 2021). Next, it is crucial all hospitals use a screening tool device as well as educate on signs and symptoms of postpartum depression and anxiety.
Some of the other determinants with this population include mothers who speak English as their second language. To help with this issue in healthcare, the proper language of screening tools needs to be utilized as well as translators. Understanding cultural norms needs to also be addressed by taking the time to talk to the patient. A study I found discussed how African American and Latino women have a 35-67% higher prevalence of developing postpartum depression (Pao, et al, 2019). Another determinant and gap in healthcare for postpartum women is economics. I found an interesting article that talks about Medicaid and depression/anxiety medication coverage postpartum. The article illustrated how with Medicaid expansion postpartum, depression/ anxiety medication coverage helped increase treatment for postpartum depression (Steenland & Trivedi, 2023).
From the readings this week, qualitative and quantitative measures were described. Some examples of quantitative measures talked about, such as the electronic health record, could relate to my population by following patients who scored high on screening tools such as the Edinburgh Postnatal Depression Scale scores for example (Curley, 2019). Qualitative measures discussed in this week’s readings described an idea called Community Advisory Boards which I feel could benefit my population (Curley, 2019). The Community Advisory Board involves a group of people such as case managers and nurses that meet and go over patient care. Telephonic calls to the patient specifically I think would tremendously benefit my population. For example, for patients who are at higher risk of developing postpartum depression such as those with a history of postpartum depression, a history of anxiety and or depression, scoring a high score on the EPDS, etc, could have healthcare personnel check in via telephone with these patients and go over education, discuss resources and schedule appointments. As future APRN’s it is crucial we help bridge the gaps for vulnerable populations!
The gap in healthcare for foster children is best summed up by its lack of consistency. Numerous studies have concluded that these children are at higher risk of having undiagnosed chronic illness, asthma, diabetes, and long-term poor health outcomes. The American Academy of Pediatrics offers many scholarly journal entries on the topic that will be highlighted below.
There is a movement in advocation for better identifying these children and implementing an 10% increase in primary care follow ups. Reid et al. (2020) describes how a 30-week period of identification and collaboration of doctors, NPs, social workers, and foster parents led to an increase in follow up care for children and an increase in quality of care reported by providers. This study highlights a qualitative measure put in place that led to an improvement of care. Additionally, Smith (2021) examines the health disparity in the state of Texas of early access to health care for foster children. The Texas Department of Family Protective Services worked with providers to implement a full needs assessment within three days of a child entering foster care to better align with national best practice standards. This study highlights another qualitative measure put in place to shed light on this issue that other states would benefit from adopting.
I find the largest gap in healthcare for this demographic is the lack of data sharing. Greiner et al (2019) addressed this issue by implementing IDENTITY, a data sharing interface between health care providers and family service professionals to help alleviate the discrepancy in information sharing for foster children. This three-year implementation process with Cincinnati Children’s Hospital streamlined communication, improved access to relevant health information that informed treatment (surgical history, allergies, immunization status, etc) and provided a place for all relevant contacts. The promising results of this study show the obvious disparity and provides qualitative and quantitative measures supporting the positive outcomes of its implementation.
Curley, A. L. C. (Ed). (2019). Population-based nursing. Springer.
Pao, C., Guintivano, J., Santos, H., & Meltzer-Brody, S. (2019). Postpartum depression and social support in a racially and ethnically diverse population of women. Archives of Women’s Mental Health, 22(1), 105–114. https://doi-org.proxy.library.vcu.edu/10.1007/s00737-018-0882-6Links to an external site.
Pluym, I. D., Tandel, M. D., Kwan, L., Mok, T., Holliman, K., Afshar, Y., & Rao, R. (2021). Randomized control trial of postpartum visits at 2 and 6 weeks. American Journal of Obstetrics & Gynecology MFM, 3(4), 100363. https://doi-org.proxy.library.vcu.edu/10.1016/j.ajogmf.2021.100363Links to an external site.
Steenland, M. W., & Trivedi, A. N. (2023). Association of Medicaid Expansion With Postpartum Depression Treatment in Arkansas. JAMA Health Forum, 4(2), e225603. https://doi-org.proxy.library.vcu.edu/10.1001/jamahealthforum.2022.5603Links to an external site.
Greiner, M. V., Beal, S. J., Dexheimer, J. W., Divekar, P., Patel, V., & Hall, E. S. (2019). Improving information sharing for youth in Foster Care. Pediatrics, 144(2). https://doi.org/10.1542/peds.2019-0580
Reid, V., Anderson, C., Elwell, J., & Meadows-Oliver, M. (2020). Improving primary care follow-up rates for youth in foster care. Pediatrics, 146(1_MeetingAbstract), 509–510. https://doi.org/10.1542/peds.146.1ma6.509
Smith, V. B. (2021). A statewide approach to increasing early access to medical care for children entering Foster Care. Council on Foster Care, Adoption and Kinship Care Program. https://doi.org/10.1542/peds.147.3_meetingabstract.84
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