Behavioral Science-informed Intervention Improves Primary Care Utilization Within 1 Year Postpartum
Key findings
- A previous report on a randomized, controlled trial showed that a relatively low-resource behavioral science–informed administrative intervention facilitated transition from postpartum to primary care for patients with chronic or pregnancy-related conditions
- This secondary analysis of the trial included all 353 patients, finding the proportion who had a non-problem–focused (or health care maintenance) primary care visit within 1 year postpartum was higher in the intervention group than with standard care (59% vs. 39%; <0.001)
- The components of the intervention, including default scheduling, tailored messages, and reminders, could be applied at a greater scale to increase primary care engagement during the postpartum period
Mass General Brigham researchers previously demonstrated in a randomized, controlled trial that default (opt-out) scheduling of primary care appointments, along with tailored messages and reminders, increased the percentage of postpartum individuals with chronic or pregnancy-related health concerns who transitioned to primary care within 4 months of their delivery.
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Overall, the improvement in primary care visits was 18.7% compared with a control group receiving routine pregnancy and postpartum care. The team questioned whether the intervention shifted the timing of the first visit among those who would have otherwise attended a primary care appointment vs. facilitated new appointments among those who would not have otherwise seen their primary care practitioner (PCP) after delivery.
To examine this hypothesis, Arlin Delgado, MD, a fellow in the Massachusetts General Hospital Department of Obstetrics & Gynecology, Mark A. Clapp, MD, MPH, a specialist in the Mass General Maternal–Fetal Medicine Program, and colleagues conducted a planned secondary analysis of the trial. In Obstetrics & Gynecology, they demonstrate that the intervention improved transitions to primary care over the first year postpartum and had other benefits for PCP engagement.
Study Methods
All 353 participants in the primary trial were followed for 1 year after their estimated due date, from November 2022 to October 2023. They were eligible for the trial because of a comorbidity with known long-term health risks: anxiety or depression (76%), pre-pregnancy body mass index ≥30 kg/m2 (40%), preexisting or gestational diabetes mellitus (20%), or chronic or pregnancy-related hypertension (16%).
The intervention (n=180) included default scheduling of an annual examination with the patient's existing PCP, labeling of the appointment as "the pregnancy–to–primary care transition appointment," other targeted language (e.g., "appointment has been reserved for you"), and appointment reminders delivered via text and electronic health portal messaging. The other 173 participants received standard pregnancy and postpartum care.
PCP Visits Were More Likely in the Intervention Group
More patients in the intervention group than in the control group attended a non-problem–focused visit (or health care maintenance visit) with a PCP within 1 year (59% vs. 39%; P<0.001). Similarly, there was a significant difference between groups in the proportion of patients who had a primary care visit for any reason (73% vs. 61%; P=0.02).
Findings were similar in a sensitivity analysis limited to the subgroup of patients whose PCP was in the same health system as their obstetric care provider.
Frequency of Primary Care Visits and Specific Services
37% of the intervention group, compared with 31% of the control group, had more than one PCP visit within the first year postpartum. This difference was not statistically significant.
The team also examined specific services by a PCP: weight and blood pressure assessments, mental health disorder screening, and a documented discussion or plan for diabetes screening and contraception. The intervention group was significantly more likely to receive mental health disorder screening (64% vs. 56% of the control group; P=0.046). Other services were numerically higher in the intervention group but not statistically different.
In sensitivity analyses limited to the subgroup of patients whose PCPs were in the same health system, 46% of the intervention group versus 34% of the control group had more than one PCP visit (P=0.01). The intervention group was also significantly more likely to have a blood pressure screening, a weight assessment, a mental health disorder screening, and a documented plan regarding their mental health.
A Scalable Solution
This intervention was less resource-intensive than the services of healthcare navigators, and it could be applied at a greater scale to increase primary care engagement during the postpartum period.
It's worth noting the substantial number of individuals who didn't have a primary care visit for any reason within 12 months after their pregnancy (27% of the intervention group and 39% of the control group). That finding highlights the need to investigate and reduce other barriers to accessing primary care and encourage ongoing care for chronic health conditions after pregnancy.
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