1001: Partnering for Prematurity Prevention: Patient navigation as an equity-promoting approach for prevention of preterm birth

Abstract

Substantial inequities exist in preterm birth (PTB) prevention efforts. Prior studies have shown non-Hispanic black (NHB) women have greater odds of non-adherence to 17-hydroxyprogesterone caproate (17P); having publicly-funded care compounded this association. Thus, we developed a prematurity-focused patient navigation program called Partnering for Prematurity Prevention (PPP) to promote 17P utilization. The objective was to assess whether PPP was associated with differences in 17P counseling, initiation, or adherence among eligible women. PPP introduced a systems-level change in which publicly-insured pregnant women who were eligible for 17P were offered a patient navigator who provided one-on-one psychosocial support, education, and barrier reduction in order to promote 17P initiation and adherence. We compared women who received prenatal care before (1/2010-9/2017) versus after (10/2017-6/2019) initiation of PPP. Outcomes included receiving documented counseling about 17P, initiation of 17P (≥1 dose), and 17P adherence (initiation ≤20 weeks of gestation, ≤1 missed dose, and continuation until 36 6/7 weeks or delivery). Of 295 eligible women (60% NHB and 21% Hispanic), 15.3% (N=45) had prenatal care after PPP initiation. Women before and after PPP initiation were demographically and clinically similar, with the exception that PPP women were more likely to have had a prior term birth in addition to their PTB (p=0.007) and had an earlier median age of their earliest PTB (p=0.002). Women seen during PPP were more likely to be counseled about 17P (100% vs 76.2%, p< 0.001), more likely to initiate 17P (93.3% vs 53.5%, p< 0.001), and more likely to be adherent to 17P (48.9% vs 27.7%, p=0.005), all of which remained significant after controlling for potential confounders (Table). In this cohort of publicly-insured, largely minority women, implementation of a clinic-wide prematurity-focused patient navigation program was associated with improved 17P utilization. Patient navigation may be an equity-promoting strategy to improve outcomes for women at risk of recurrent PTB.