Postpartum Transition Support Increases Primary Care Engagement, Reduces Risk of Readmission

Nearly twice as many women with a chronic health condition who participated in a postpartum transition support intervention completed a primary care visit within 4 months after giving birth compared with a control group that did not participate, according to new research from Massachusetts General Hospital and the Harvard TH Chan School of public Health, in Boston.

Specifically, 40% in the group that received an automated scheduling and reminder package attended a follow-up visit with a primary care clinician during that first 4 months after giving birth compared with 22% of those who did not. The likelihood of completing the follow-up increased by nearly 19% among women who participated.

The burden of chronic disease in US pregnancies has been increasing, according to study authors writing in JAMA Network Open, but transition to primary care after delivery is "uncommon" among women with chronic conditions. They cite diabetes, hypertension, or obesity as conditions documented in more than 30% of pregnancies and anxiety or depression in up to 22%. Although individuals with such diseases are often followed and monitored carefully during gestation, nearly 50% do not see a primary care clinician at all during the postpartum year. Often described as the "postpartum cliff," the abrupt change from willing and high engagement with the health care system to limited or no contact after giving birth reflects a "missed opportunity to improve prevention and management of chronic disease."

The missed opportunity is due in part, authors say, to the absence of health care system support for the transition. The current study was designed to evaluate the impact of an intervention that would improve postpartum primary care engagement by reducing the administrative burden on women after giving birth.

To be eligible, women were required to have obesity, anxiety or depressive mood disorder, type 1 or 2 diabetes, chronic hypertension, or pregnancy-related hypertension.

There were 180 participants in the intervention group and 173 in the control group. The intervention "bundle" included an introductory message sent via text about the importance of a post-delivery appointment with primary care that would be scheduled on their behalf if they did not opt out. Appointment reminders were sent approximately 1 month after the estimated due date and 1 week before the scheduled appointment via the EHR patient portal and SMS.

The primary outcome was defined as completion of a primary care visit within 4 months of EDD; secondary outcomes of interest were obstetric triage visit, emergency department or urgent care use, and hospital readmission within 4 months after delivery.

Mean age of participants was 34.1 years with median gestational age of 36.3 weeks at study enrollment. Chronic disorders reported among them included depression (75.4%), obesity (40.8%), chronic or pregnancy-related hypertension (16.1%), and preexisting gestational diabetes (19.5%).

A greater proportion of women in the intervention group received chronic condition related screening, ie, blood pressure (42.8% vs 28.3%), weight assessment (42.8% vs 27.7%), and depression (32.8% vs 16.8%). Moreover, although obstetric triage visits and emergency department or urgent care use did not differ between the groups, postpartum readmissions were significantly lower in the intervention group, at 1.7% vs 5.8% in the control group.

"Targeting this population at a time of high health activation and motivation, this intervention represents a potentially scalable approach to increasing primary care engagement and ongoing health condition management in the postpartum months and beyond," authors wrote. "Ongoing follow-up related to this study seeks to analyze condition-specific management (ie, the content and quality of care provided in the postpartum period) and long-term health outcomes."

Source: Clapp MA, Ray A, Liang P, James KE, Ganguli I, Cohen JL. Postpartum primary care engagement using default scheduling and tailored messaging: a randomized clinical trial. JAMA Netw Open. 2024;7(7):e2422500. doi:10.1001/jamanetworkopen.2024.22500