OBJECTIVE: To evaluate the effect of a behavioral science-informed intervention designed to facilitate postpartum-to-primary care transitions on primary care visits and screenings within 1 year postpartum for individuals with chronic conditions or pregnancy conditions with long-term health risks.
METHODS: This was a planned secondary analysis of a randomized controlled trial of a behavioral science-informed intervention designed to increase primary care practitioner (PCP) visits within 4 months postpartum compared with routine care. The intervention included default PCP visit scheduling with nudge reminders and use of tailored language. The primary outcome for this secondary analysis was attending an annual examination or health care maintenance visit with a PCP within 1 year postpartum. Visits with a PCP for any reason and receipt of screenings or services by a PCP (eg, weight, blood pressure, mood screening) were also compared. Outcomes were compared between groups with ?2 testing.
RESULTS: All 353 participants were followed through 1 year after their due dates: 173 in the control group and 180 in the intervention group. More patients in the intervention group attended an annual examination with a PCP within 1 year compared with the control group (59.0% vs 39.3%, P<.001) and had a PCP visit for any reason (72.8% vs 61.3%, P=.02). A significantly higher rate of mental health disorder screening was observed in the intervention group (63.9% vs 55.5%, P=.046); significant differences in other screenings were not observed.
CONCLUSION: This relatively simple and low-cost intervention designed to facilitate transition from postpartum to primary care within the first 4 months demonstrated benefits for PCP engagement within the first year postpartum.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05543265.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
As a primary care physician and medical director, it's useful to have data to show that this kind of routine scheduling can increase mood-disorder screening and general attendance in annual visits. I'm curious what other effects it has on practice. If the intervention group all gets booked for annual visits but the show rate is 60%, how are they accounting for so many no-shows (and is that no-show rate high for their practice)? And, of course, getting the screening is beneficial, but what we really want to know is whether outcomes improve. We hope so because they got more screening, but we don't have the outcome data. So, this is relevant and vaguely useful.
Physician rater
This article shows the importance of developing systems to "nudge" high-risk patients to attend outpatient appointments. This provides data on how to structure reminders for higher risk patients with other medical issues. The population in this study was post-partum women with higher risk factors. This is an important population and the interventions used in this study will have benefit to a high number of individuals. This may have benefit for hospital systems to implement these reminders and "nudges."
, McMaster University