A recent study by the University of Arkansas for Medical Sciences reports that postpartum mothers receiving telehealth services experience higher rates of screenings for things like cigarette smoking, emotional and physical abuse, and postpartum depression.
Don Willis is a researcher at the UAMS Institute for Community Health Innovation. He recently spoke with Ozarks at Large about this study.
Don Willis: Our view of the role virtual care should be playing is as complementary—not as a substitute—for those in-person visits. There's still a ton of care that really needs to be done in person.
As far as what the experience looks like for the women themselves, I'm probably not the best spokesperson for that. But I think what we know from the literature—beyond what this particular study did—is that people tend to report really positive experiences, both patients and providers. Outcomes tend to be, for the most part, equal and in some cases better for women that are getting virtual care.
In the case of these screenings, we see a pretty clear benefit. Although I do want to be clear that we're not claiming a causal relationship here. All we've documented so far is an association. We know that women who are getting any virtual care are also getting screened at higher rates. We don't know what the cause of that is, and we don't know, for example, when those screenings are occurring—whether at the virtual visit or at an in-person visit. We just know they're more likely to have gotten the screening.
So there's future research that still needs to be done to fully understand what the relationship here looks like.
Moore: Can you talk a bit about the necessity for even having postpartum care and postpartum check-ins in this way?
Willis: Yeah. We know, nationally, over 80% of maternal deaths are preventable. The majority of those occur during the postpartum period—between 7 and 365 days after giving birth. So we know it's a really critical period to intervene on new mothers’ health and to potentially save lives.
Nationally, the U.S. has a lot of work to do to improve maternal mortality and morbidity. Especially here in Arkansas, it's something that a lot of folks are working hard to improve.
This postpartum period is just one of those really critical periods where we know new moms do need a lot of support. They need to be supported not just through our healthcare systems, but informally as well—through new dads and other family members.
These postpartum visits are critical for a number of reasons. And these screenings are just a few of those reasons why. Because we know that not only are maternal mortality rates higher than they should be—ideally, we’d like to see no mortality—but some of the leading causes for pregnancy-associated deaths are things like suicide and homicide. So that’s why screening for depression and for physical and emotional abuse is really, really critical. Screening for those things could be important interventions for those leading causes of pregnancy-associated deaths.
Moore: As you point out in the research, typically a postpartum appointment happens around the 4- to 6-week mark. For some people, they may be starting to go back to work at that point. This can lead to some of the effects we see in postpartum depression or other symptoms.
It also plays a role in someone’s ability to attend an in-person appointment. If someone is going back to work, they’ve already missed a large chunk of time. Having a virtual appointment where they can step out in their car for just a few minutes during a lunch break might mean the difference in being able to hold down a job—and not.
Willis: Right. Yeah, absolutely.
We know that postpartum care visits themselves—we need to increase attendance. And they come with a large set of possible barriers: Can I get childcare? Can I take time off from my job, especially if I’ve already gone back to work? Transportation issues are really critical.
The virtual care visit can help overcome some of those barriers. But at the same time, it’s important to realize that virtual care also comes with its own set of barriers: internet access, having a private space to conduct the visit.
Now, the findings from our study suggest that for the most part, women seem to be able to overcome those barriers. But we assume that’s not the case for all women.
What’s really interesting is when we look at some of these counseling and screening outcomes, it seems to be—particularly for sensitive subjects—there might be a higher comfort level discussing topics like depression or physical abuse.
Of course, you have to take extra precautions if you're screening for physical and emotional abuse virtually. You may not know if the abuser is in the same room, so it's critical to make sure someone has a private space for those conversations.
Moore: As someone who thinks about this on an academic level, how do you make sure that you don't let "good enough" be the enemy of "great"? Especially when we're thinking about postpartum care—that perhaps virtual care being “good enough” doesn’t mean we stop trying to improve.
Willis: That’s a good question. Ideally, the outcome is we are losing zero lives.
We always want to be striving for the best possible outcomes for all folks being served through our healthcare systems. The way we don’t let “good enough” get in the way of that is by not stopping. We keep trying to improve.
Like I said earlier, virtual care seems to be improving the rate of some screenings, but they're still not where we want to be. And as I also said, virtual care comes with its own barriers. It’s not going to be the absolute solution to access because we still have internet access issues, and people living in environments that are too crowded for private health conversations.
So, it’s important to be realistic: What can this help us with, and to what degree?
We know it's not going to solve everything, but it can help move us in the right direction. And we don't want to stop there. We want everyone to get care, and hopefully, everyone gets screened for what they need.
Moore: I think it’s important to talk about postpartum care as a continuum. Once you move from postpartum, you want to make sure you're caring for her as a new mother—and as a woman who has given birth. So perhaps virtual care can be looked at as a starting point.
If there are a lot of barriers keeping someone from coming in, let’s at least remove one barrier and say, "We want to take care of you." That might open the door to more comfort, more willingness to try in-person care later.
Willis: Yeah, absolutely. There's a big push to think about postpartum care as a continuum and to avoid gaps in that care.
I do think virtual care can help make that continuum more seamless. But we're still learning a lot—what those experiences are like, who even has access to virtual care. It grew in popularity during the pandemic, but it's still not universally available.
A couple of takeaways from this work: one, it’d be great if more people had the option of virtual care—not as a substitute, but as a complementary option for folks facing barriers to in-person visits.
Two, when we look at screening rates among patients receiving virtual care, we still want them to be higher. There are still missed opportunities to intervene on the leading causes of pregnancy-associated deaths.
For a lot of health issues and inequities, solutions can seem abstract or overwhelming. But here, we have a really practical step we can take to improve outcomes—and that’s simply making these screenings more consistent.
There may be assumptions being made about which patients are experiencing depression or abuse, and I don't know if that’s limiting who gets screened and who doesn’t. That’s something future research could explore.
We certainly want to know more about why these questions are getting asked more often for patients who get virtual care.
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