Effect of Enhanced Prenatal and HIV-Focused Services for Pregnant Women Who Are Infected by Human Immunodeficiency Virus on Emergency Department Use

OBJECTIVES: This study examines whether the receipt of enhanced prenatal or human immunodeficiency virus (HIV) medical services is associated with in-pregnancy emergency department (ED) utilization by HIV-infected women. METHODS: Medicaid and vital statistics records were linked for 1,826 women who are infected by HIV and who were delivered from 1993 to 1995 while receiving New York State Medicaid. The authors examined two types of ambulatory care--the Prenatal Care Assistance Program (PCAP) and enhanced care focused on HIV--that offer additional services in exchange for increased Medicaid reimbursement. From logistic regression models, the authors estimated adjusted associations of these types of care with ED use during pregnancy not leading directly to hospitalization. RESULTS: Fifty-three percent of pregnant women visited the ED. Women with ED use averaged 2.0 visits (SD = 1.1). After adjustment for demographic and substance use factors, enhanced care focused on HIV was not associated with any ED use (OR = 1.11, 95% CI 0.94, 1.30) or, among those using the ED at least once, with number of visits (P = 0.84). Interactions of receipt of PCAP care with the Adequacy of Prenatal Care Utilization Index (APNCU) and having a usual source of care in pregnancy improved model fit (P < 0.001 and P = 0.06, respectively). PCAP was associated with increased ED use only among women with inadequate APNCU or no usual source of prenatal care. CONCLUSION: Pregnant women infected with HIV receiving Medicaid relied heavily on ED care. Use of the ED was not associated with services focused on HIV but was positively associated with enhanced prenatal care. The association of enhanced prenatal care with greater ED use was curbed for women with more timely and adequate prenatal care visits or a usual source of prenatal care

Ambulatory care · Emergency department · Environmental health · Family medicine · Health care · Logistic regression · Medicaid · Medical record · Population · Pregnancy · Prenatal care · Receipt · Adolescent Sexual and Reproductive Health · Emergency Medicine · Global Maternal and Child Health · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Nursing

• Health Promotion and Psychosocial Services and Women’s Assessments of Interpersonal Prenatal Care in Medicaid Managed Care

  Open Access•Carol C Korenbrot, Sabrina T Wong et al.•Maternal and Child Health Journal•2005

  Incluir item

• Organization of care for persons with HIV-infection

  Curtis D Handford, Anne-Marie Tynan et al.•AIDS Care•2017

  Incluir item

• Longitudinal data analysis using generalized linear models

  Kung-Yee Liang, Kung‐Yee Liang et al.•Biometrika•1986

  Incluir item

• Psychosocial factors influencing non-urgent use of the emergency room

  Open Access•D K Padgett, Beth Brodsky et al.•Social Science & Medicine•1992

  Incluir item

• An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index

  Milton Kotelchuck•American Journal of Public Health•1994

  Incluir item

• Emergency room use and primary care case management

  R E Hurley, R Hurley et al.•American Journal of Public Health•1989

  Incluir item

• The Municipal Health Services Program

  Gretchen V Fleming, Ronald Andersen et al.•Medical Care•1986

  Incluir item