Abstract
ABSTRACTImportanceDespite careful monitoring of chronic and gestational conditions during pregnancy, most postpartum individuals with (or at high risk for) chronic conditions are not engaged in primary care following delivery. This lack of postpartum obstetric-to-primary care transition reflects a missed opportunity to improve short- and long-term health and well-being.ObjectiveTo evaluate the efficacy of a behavioral economics-informed intervention designed to reduce patient administrative burden and information gaps on postpartum primary care visit completion.DesignIndividual-level randomized controlled trial.SettingAcademic obstetric practice that included hospital- and community-based outpatient clinics.ParticipantsEnglish- and Spanish-speaking pregnant or recently postpartum adults who had obesity (pre-pregnancy body mass index (≥30 kg/m2)), anxiety or depressive mood disorder, type 1 or 2 diabetes mellitus, chronic hypertension, gestational diabetes, and pregnancy-related hypertension listed in their medical record were eligible to participate. Participants also were required to have a primary care clinician (PCP) listed in their electronic health record.InterventionA behavioral economics-informed intervention bundle, which included automatic scheduling of PCP appointments after delivery, patient-tailored health information, and appointment reminder nudges.Main OutcomeAttending a “health care maintenance” (i.e., “annual exam”) appointment or receiving disease-specific management relating to the eligibility criteria (obesity, anxiety/depression, diabetes, or hypertension) by a PCP within 4 months of delivery.Results360 patients were randomized: 176 to the control group and 184 to the intervention group. primary outcome occurred in 22.0% in the control group and 40.0% in the intervention group (p<0.001). In the regression model that accounted for the randomization strata, the intervention increased PCP visit completion within 4 months of a patient’s EDD by 19.9 percentage points (95% confidence interval (CI) 10.7-29.1).Conclusions and RelevanceStandard postpartum care practice encourages but does not facilitate transitions from obstetric to primary care. This study found that a behavioral science-informed intervention designed to facilitate this transition through default PCP visit scheduling, tailored messages, and nudge reminders substantially increased postpartum primary care visit completion for patients with or at risk for common comorbidities. This intervention represents a potentially low-cost and scalable solution to increase primary care engagement and ongoing health condition management after pregnancy, a time of high engagement and health activation.Trial RegistrationNCT05543265.
Publisher
Cold Spring Harbor Laboratory