Automated scheduling boosts PCP visits among pregnant, postpartum women

Key takeaways:

• Primary care visit completion occurred in 40% of intervention participants vs. 22% of control group participants.
• The intervention also increased services like weight assessments and BP screening.

Automated appointment scheduling and reminder messages improved receipt of care and various screenings among women with chronic medical conditions and who were pregnant or recently gave birth, results from a randomized study showed.

“Individuals with chronic and mental health conditions typically have frequent contact with obstetrical care providers while pregnant but often are largely left to navigate ongoing care needs on their own after delivery — referred to as the ‘postpartum cliff,” Mark A. Clapp, MD, MPH, an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, said in a press release. “Among other factors, this ‘cliff’ is caused by administrative burdens, such as appointment scheduling and navigating insurance, which make it difficult for individuals to seek care.”

The researchers conducted a randomized controlled trial where 360 women (mean age, 34 years) with obesity, type 1 or 2 diabetes, mental health disorders or pregnancy-related hypertension were assigned to either a control group with usual scheduling of postpartum primary care visits or to an intervention.

The intervention included:

• a targeted introduction message about the importance of seeing a primary care provider after delivery;
• a study staff member making a PCP appointment within 4 months after the participant’s estimated due date and on the participant’s behalf; and
• visit reminder messages that were sent 1 month before the participant’s estimated due date and 1 week before the scheduled appointment.

If a participant had completed their annual PCP visit within the year, they were still scheduled for an appointment for when they were next eligible, even if it was outside the study’s follow-up period.

The study’s primary outcome was the completion of a PCP visit for routine or chronic condition care within the 4-month window, while the researchers also assessed the likelihood of a patient having a primary care visit that involved services like BP screening, mood screening or weight screening.

Primary care visit completion occurred in 40% (95% CI, 33.1%-47.4%) of participants in the intervention group and in 22% (95% CI, 6.4%-28.8%) of those in the control group.

Overall, the intervention increased primary care visit completion by 18.7 percentage points (95% CI, 9.1-28.2 percentage points).

Clapp and colleagues also found that intervention participants had fewer postpartum readmissions compared with control group participants (1.7% vs. 5.8%), in addition to increased BP screenings (42.8% vs. 28.3%),weight assessments (42.8% vs. 27.7%) and mood screenings (32.8% vs. 16.8%).

“Our findings indicate that a multifaceted and relatively low-resource behavioral economic intervention may improve postpartum health and well-being,” Clapp said in the release.

There were several study limitations. For example, Clapp and colleagues were unable to assess the effectiveness of the intervention’s individual components due to it being a bundled intervention.

“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,” they wrote in JAMA Network Open. “Similarly, as many individuals still did not attend a PCP appointment within 4 months even with the assistance of this intervention, additional investigations should focus on identifying and addressing remaining barriers to transitioning to primary care after pregnancy.”

References:

• Automated appointment scheduling and reminder messages may improve post-partum health and well-being for those with chronic health conditions. Available at: https://www.massgeneral.org/news/press-release/automated-postpartum-appointment-scheduling-improves-primary-care. Published July 16, 2024. Accessed July 22, 2024.
• Clapp M, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.22500.