(837) Provider Remote Obstetrics-Related Employment Education for Pregnant and Postpartum Patients: A Pilot Study

Obstetric providers are rarely trained on employment laws that impact pregnant workers. Thus, we developed the Provider Remote Obstetric-Related Employment Education (PROMOTE) intervention, a 30-minute online training and documentation toolkit.  We pilot-tested PROMOTE and evaluated the employment experiences, care adherence, and financial strain of patients.  

Study Design:

We conducted a pre/post intervention pilot at a single high-risk OB clinic. Patients who self-identified as Black or White race between 24 weeks gestation – 12 weeks postpartum with wage-earning employment were surveyed at a single timepoint about their employment experiences using the NIH PhenX toolkit and a validated financial stain index. Outpatient appointment adherence was determined via chart review. PROMOTE was offered over three months to all clinical team members. The post-intervention patient group was recruited using the same criteria.  We compared employment experiences, financial strain, and outpatient visit adherence by pre- and post-intervention, self-identified race, and hourly vs salaried employment using descriptive statistics with SAS 9.4 (SAS Institute Inc., Cary, NC).

Results:

42 clinical team members completed the PROMOTE training. 97 patients (50 pre- and 47 post-intervention) completed surveys. Demographics were similar between the two groups (Table 1). There were no differences in financial strain or adherence to outpatient visits between the pre- and post-intervention groups (Table 2). Black participants had higher financial strain than their White counterparts (8.9 (3.7) vs 5.0 (2.6), p < 0.0001), as did hourly workers compared to salaried (8.5 (3.8) vs 4.9 (2.5), p < 0.0001). Hourly employed respondents were more likely to report a decrease in their work hours during pregnancy (30.8% vs 6.7% for salaried workers, p = 0.0058).

Conclusion:

While we did not detect any pre/post PROMOTE differences in financial strain or adherence to care, we demonstrate the need for Black and hourly workers to be well represented in future studies on employment as a social driver of obstetric outcomes.