Length of postpartum hospital stays during COVID-19: Findings from a convergent parallel mixed-methods study.

OBJECTIVE: We examined length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences. METHODS: We conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative). We linked multiple health administrative datasets at ICES and developed multivariable linear regression models to examine length of hospital stay (quantitative). We conducted semi-structured interviews using qualitative descriptive to understand experiences of postpartum hospitalization (qualitative). Data integration occurred during design and interpretation. RESULTS: Relative to 2019, postpartum hospital stays decreased significantly by 3.29 hours (95% CI: -3.58 to -2.99; 9.2% reduction) in 2021 and 3.89 hours (95% CI: -4.17 to -3.60; 9.0% reduction) in 2022. After adjustment, factors associated with shortened stays included: giving birth during COVID-19, social deprivation (more ethnocultural diversity), midwifery care, multiparity, and lower newborn birth weight. Postpartum hospital experiences were impacted by risk perception of COVID-19 infection, clinical care and hospital services/amenities, visitor policies, and duration of stay. CONCLUSION: Length of postpartum hospital stays decreased during COVID-19, and qualitative findings described unmet needs for postpartum services. The integration of large administrative and interview data expanded our understanding of observed differences. Future research should investigate the impacts of shortened stays on health services outcomes and personal experiences. OBJECTIF: Nous avons examiné la durée d'hospitalisation post-partum pour les cas de naissance vivante pendant la pandémie de COVID-19 et exploré comment les circonstances de la pandémie ont influencé l'expérience post-partum à l'hôpital. MéTHODES: Nous avons mené une étude interprovinciale selon un modèle mixte parallèle et convergent en Ontario (Ont.) et en Colombie-Britannique (C.-B.), au Canada. Nous avons inclus les personnes ayant accouché à l'hôpital en Ont. entre le 1 janvier et le 31 mars 2019, 2021 et 2022 (quantitatif), et celles ayant accouché (≥ 18 ans) entre le 1 mai 2020 et le 1 décembre 2021 en Ont. ou en C.-B. (qualitatif). Nous avons relié plusieurs ensembles de données de santé administratives à l'ICES et développé des modèles de régression linéaire multivariable pour examiner la durée d'hospitalisation (quantitative). Nous avons mené des entretiens semi-structurés en utilisant une méthode qualitative descriptive pour comprendre les expériences d'hospitalisation post-partum (qualitative). L'intégration des données a eu lieu pendant la conception de l'étude et l'interprétation. RéSULTATS: Par rapport à 2019, la durée de l'hospitalisation post-partum a significativement diminué de 3,29 heures (IC à 95 % : -3,58 à -2,99; réduction de 9,2 %) en 2021 et de 3,89 heures (IC à 95 % : -4,17 à -3,60; réduction de 9,0 %) en 2022. Après ajustement, les facteurs associés à la réduction de la durée d'hospitalisation étaient les suivants : accouchement pendant la pandémie de COVID-19, manque de socialisation (plus grande diversité ethnoculturelle), prise en charge en pratique sage-femme, multiparité et poids plus faible du nouveau-né à la naissance. L'expérience d'hospitalisation post-partum était influencée par la perception du risque de contracter la COVID-19, les soins cliniques et les services et commodités à l'hôpital, les politiques relatives aux visiteurs et la durée de l'hospitalisation. CONCLUSION: La durée d'hospitalisation post-partum a diminué pendant la pandémie de COVID-19, et les résultats qualitatifs ont décrit des besoins non satisfaits en matière de services post-partum. L'intégration de grands ensembles de données administratives et d'entretiens a permis de mieux comprendre les différences observées. Les recherches futures devront se pencher sur l'impact de la réduction de la durée d'hospitalisation sur les résultats des services de santé et les expériences personnelles.

Legacy Drug-Prescribing Patterns in Primary Care.

PURPOSE: Polypharmacy is a key clinical challenge for primary care. Drugs that should be prescribed for an intermediate term (longer than 3 months, but not indefinitely) that are not appropriately discontinued could contribute to polypharmacy. We named this type of prescribing legacy prescribing. Commonly prescribed drugs with legacy prescribing potential include antidepressants, bisphosphonates, and proton pump inhibitors (PPIs). We evaluated the proportion of legacy prescribing within these drug classes. METHODS: We conducted a population-based retrospective cohort study using prospectively collected data from the McMaster University Sentinel and Information Collaboration (MUSIC) Primary Care Practice Based Research Network, located in Hamilton, Ontario. All adult patients (aged 18 or older) in the MUSIC data set during 2010-2016 were included (N = 50,813). We calculated rates of legacy prescribing of antidepressants (prescription longer than 15 months), bisphosphonates (longer than 5.5 years), and PPIs (longer than 15 months). RESULTS: The proportion of patients having a legacy prescription at some time during the study period was 46% (3,766 of 8,119) for antidepressants, 14% (228 of 1,592) for bisphosphonates, and 45% (2,885 of 6,414) for PPIs. Many of these patients held current prescriptions. The mean duration of prescribing for all legacy prescriptions was significantly longer than that for non-legacy prescriptions (P <.001). Concurrent legacy prescriptions for both antidepressants and PPIs was common, signaling a potential prescribing cascade. CONCLUSIONS: The phenomenon of legacy prescribing appears prevalent. These data demonstrate the potential of legacy prescribing to contribute to unnecessary polypharmacy, providing an opportunity for system-level intervention in primary care with enormous potential benefit for patients.

Voices in the wilderness: Co-location meeting the needs of children in protective care.

OBJECTIVE: To explore how access to a family medicine clinic co-locating with the Children's Aid Society (CAS) of Hamilton in Ontario helped meet the unique needs of children in care. DESIGN: Qualitative research using semistructured face-to-face and telephone interviews. SETTING: The CAS of Hamilton. PARTICIPANTS: Nineteen foster parents. METHODS: Stakeholders were invited to participate with flyers posted in the clinic, notices that were mailed to foster parents, personal invitations that were distributed during clinic visits, and an internal memo that was distributed to the CAS staff. Informed consent and assent where appropriate was obtained before an interview was started. Interviews were audiorecorded when and where feasible, transcribed, and subsequently underwent inductive, thematic analysis. Common themes evolved by consensus. MAIN FINDINGS: Foster parents valued the family medicine clinic co-locating with the CAS. The co-location helped children in care to know that there were others in similar circumstances. Foster parents learned from and shared parenting skills with one another, which resulted in developing confidence in the care they provided. The clinic became a neutral place for children in care, foster parents, and birth parents. The clinic team gathered the children's complete health records and was responsible for sharing this information when appropriate. CONCLUSION: Access to a family medicine clinic designed specifically for children in care that co-located with the CAS enhanced not only the planning, management, and evaluation of care, but also provided a consistency that was not found in other parts of the children's lives; this helped generate trusting relationships over time. The co-location provided a strong spoke in the circle of care.

How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol.

INTRODUCTION: Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic. OBJECTIVES: Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.Qualitative strand: Understand how pregnant people's perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health. METHODS AND ANALYSIS: This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation. ETHICS AND DISSEMINATION: This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics. TRIAL REGISTRATION: Registration: Clinicaltrials.gov registration number: NCT05663762.