Postpartum Intervention Improved PCP Visits in Year After Delivery

A postpartum intervention that prescheduled an annual primary care provider (PCP) appointment for pregnant participants increased their likelihood of visiting their PCP within the year after delivery, according to research presented at the Society of Maternal-Fetal Medicine 2src25 Pregnancy Meeting. 

Prenatal visits during pregnancy often comprise a period of “high health activation and motivation for self-care,” Arlin Delgado, MD, a Maternal Fetal Medicine Fellow at Massachusetts General Hospital, Boston, told attendees. But after discharge from obstetric care, there’s often “a drop in patient engagement with the healthcare system, with many patients not reestablishing care with their PCP,” a phenomenon referred to as the “postpartum cliff,” she said.

“The postpartum cliff leaves an accountability limbo in which patients and providers are both unsure of who is primarily accountable for their care and often with questions regarding the need for medications, ongoing screening, and treatment,” Delgado said. Since patients are often diagnosed during pregnancy with conditions that require ongoing care and screenings, this postpartum period is often a missed opportunity for better care coordination. 

The researchers therefore developed the Bridge Pilot Study to see if they could ease the transition from obstetric to primary care. 

The intervention had several bundled components. The first was the default scheduling of an annual exam with the patient’s PCP within 4 months of their estimated due date, labeled in the system as “Pregnancy-to-Primary Care Transition Appointment.” 

“It can be so easy for parents to prioritize their baby’s needs over their own, especially in those early months. Offering support like appointment scheduling is a smart way to help them prioritize their own well-being without adding extra mental load,” said Micole Galapo-Goldstein, MSN, a family nurse practitioner and lactation consultant.

“If the intervention is helping to streamline the process, it could also allow for better communication between healthcare providers and families. That way, there’s less chance for information to be lost or misunderstood during such a critical time,” she said. 

The intervention also involved language tailored to the pregnancy-to-primary care transition and two nudge reminders texted to the patients. The control group meanwhile received routine pregnancy and postpartum care.

The initial trial, running from November 2src22 to April 2src23, included 36src patients with at least one comorbidity: Anxiety/depression, obesity, chronic hypertension, or any type of diabetes. In that trial, 4src% of patients receiving the intervention went to their PCP visit compared with 22% in the control group (P <.srcsrc1). 

This planned secondary analysis looked at differences in PCP engagement between the groups 12 months after delivery. 

The population included 173 patients from the control group and 18src patients from the intervention. They were an average 34 years old and mostly non-Hispanic (77%), White individuals (7src%), with 22% covered by Medicaid. Most of the participants (76%) had anxiety or depression, and 4src% had a pre-pregnancy body mass index> 3src. In addition, 2src% had preexisting or gestational diabetes, and 15% had a hypertensive disorder. About two thirds (68%) had a PCP in the same health system as their ob/gyn, and nearly all (93%) had attended a postpartum visit within 4-8 weeks of delivery.

Significantly more patients who received the intervention (59.4%) than those in the control group (39.3%) had an annual exam within 1 year, a difference driven primarily by intervention group participants visiting their PCP in the first 4 months after delivery (P <.srcsrc1). Among those with a PCP in the same system as their ob/gyn, 72.6% of intervention group participants had a PCP annual visit compared to 49.2% of control group participants (P <.srcsrc1).

“Making the PCP connection is a proactive part of a long-term process of living a healthy lifestyle,” Galapo-Goldstein said. “The study interventions generated a seamless transition from one provider to another.”

Galapo-Goldstein also noted the value of including the ob/gyn in discussion of annual PCP visits at the end of prenatal and postpartum appointments to reinforce the importance of ongoing care in the year after delivery.

Beyond annual visits, there was no significantly greater engagement with PCPs overall in the intervention group. However, among participants whose ob/gyn and PCP were in the same health system, there was slightly greater engagement among those in the intervention group; 46% in the intervention group, compared with 34% in the control group, had two or more visits (P=.src1).

Though patients in the intervention group had only a trend toward fewer emergency department visits, they were almost half as likely as those in the control group to visit urgent care (adjusted odds ratio [aOR], src.57; 95% CI, src.34-src.98).

Overall, patients in the intervention group had over twice the odds of seeing their PCP for an annual visit compared with those in the control group (aOR, 2.77; 95% CI, 1.75-4.4). Those in the intervention group were also significantly more likely to see any PCP for any reason (aOR, 1.91), and to see their own PCP for any reason (aOR, 1.74). 

The trial was limited by exclusion of patients who didn’t have a PCP listed in the EHR and by the predominantly White, privately insured, college-educated population. 

“Black women, in particular, face significant disparities in healthcare access and outcomes, including difficulties with establishing long-term relationships with primary care providers,” Galapo-Goldstein said. “These challenges can lead to gaps in care, delayed diagnoses, and worse health outcomes overall. Proactively connecting Black women to a PCP during the postpartum visit could help address some of these disparities by ensuring they have a consistent point of contact for their healthcare needs.” 

The research was funded by the National Institute on Aging, the NBER Roybal Center for Behavior C