(365) Relationship between discharge medication delivery location and postpartum follow-up in hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality extending to the postpartum period. Hospitals utilize several methods of postpartum (PP) prescription delivery for oral antihypertensives, including bedside medication delivery, in-hospital, or outside pharmacy prescription. Our primary objective was to determine if method of prescription of discharge anti-hypertensives impacted attendance and blood pressure at the first PP follow up visit. Secondary outcomes included blood pressures, 6 week PP visit attendance, and readmission rates.

Study Design:

This is a secondary analysis of a quality improvement project for HDP at an urban tertiary care center between October 2018 and June 2020.  Location of PP medication prescription was separated into in-hospital pharmacy (bedside delivery and in-hospital pharmacy) and out-of-hospital pharmacy. Demographic and clinical data including PP outcomes and follow up visit blood pressures were collected through chart review. A Wilcoxon Rank-Sum test, chi-square, and Fisher exact test were used as appropriate. A logistical model was used to adjust for confounders.

Results:

357 patients were included, with 84 patients receiving in-hospital and 273 receiving out-of-hospital medications. Only 6% of patients used bedside delivery. In hospital pharmacy was used more by those with infants in the NICU (p=0.02) and out-of-hospital pharmacy was used more by those with primary OB at study hospital (p=0.04). Patients using out-of-hospital pharmacy were more likely to attend both early (p=0.04) and 6-week PP visits (p=0.045), but blood pressures were not different. After adjustment for confounders, there was no difference in early follow up rates (aOR 0.662, 95% CI 0.368-1.189). Location of pharmacy did not affect PP re-admissions (p=0.43).

Conclusion:

Pharmacy location for prescribed antihypertensives does not impact PP blood pressures to visit follow ups, but rather may represent varying patient characteristics.  Further work is needed to determine strategies to reduce PP care barriers.