{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:09:11Z","timestamp":1778742551229,"version":"3.51.4"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:00:00Z","timestamp":1735084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:00:00Z","timestamp":1735084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To estimate the rate of ambulatory care use among postpartum persons by rurality of residence and pregnancy\u2010related conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used Maine Health Data Organization's All Payer Claims Data for persons who delivered between 2007 and 2019 (N = 121,905). We estimated rates of ambulatory care (nonemergency department outpatient health care) utilization during the first 24 months\u2019 postpartum by level of rurality (urban, large rural, small rural, and isolated rural) and by pregnancy\u2010related conditions (prenatal depression, hypertensive disorders of pregnancy, and gestational diabetes). To estimate rate ratios (RR), we used Poisson regression with an offset for population at risk, adjusting for potential confounders and restricting the analysis to those with continuous insurance (n = 70,431).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The mean monthly rate per 100 deliveries of ambulatory care visits was 86.1; the median number of visits was 12 (interquartile range = 6, 25). Persons living in rural areas had lower monthly rates of visits than persons living in urban areas (adjusted RR ranged from 0.87 [95% CI: 0.85, 0.89] in isolated rural areas to 0.91 [95% CI: 0.90, 0.93] in large rural areas). Persons with prenatal depression (aRR = 2.07; 95% CI: 2.04, 2.11), hypertensive disorders of pregnancy (aRR = 1.07; 95% CI: 1.05, 1.10), and gestational diabetes (aRR = 1.11; 95% CI: 1.08, 1.14) had higher rates of visits than those without these conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>New practices and policies may be needed to improve postpartum ambulatory care access and utilization in rural areas. Postpartum persons with pregnancy\u2010related conditions are accessing ambulatory care at higher rates after delivery, which may reduce their need for acute health care use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.12912","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T01:05:17Z","timestamp":1735175117000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ambulatory care utilization in the first 24 months\u2019 postpartum by rurality and pregnancy\u2010related conditions: A prospective cohort study from Maine"],"prefix":"10.1111","volume":"41","author":[{"given":"Sydney M.","family":"Bebus","sequence":"first","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Palmsten","sequence":"additional","affiliation":[{"name":"Pregnancy and Child Health Research Center HealthPartners Institute  Bloomington Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather S.","family":"Lipkind","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Weill Cornell Medical College  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina M.","family":"Ackerman\u2010Banks","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-9208","authenticated-orcid":false,"given":"Katherine A.","family":"Ahrens","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1025399"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs\u20104014132\/v1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002633"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14247"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13579"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-016-2043-8"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00547"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004359"},{"key":"e_1_2_9_10_1","unstructured":"RandolphR ThomasS HolmesM et\u00a0al.Rural Population Health in the United States: A Chartbook. 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