Postpartum Primary Care Engagement Using Default Scheduling and Tailored Messaging: A Randomized Clinical Trial

Area of Science:

• Obstetrics and Gynecology
• Primary Care Medicine
• Health Services Research

Background:

• Over 30% of pregnant individuals have chronic conditions, and nearly 20% develop gestational diabetes or hypertension, increasing future disease risk.
• Postpartum transition to primary care is challenging for high-risk individuals due to limited healthcare support and administrative burdens.

Purpose of the Study:

• To assess an intervention's effectiveness in enhancing postpartum primary care engagement.
• To reduce administrative burdens and information gaps for patients transitioning to primary care.

Main Methods:

• Individual-level randomized clinical trial involving 360 postpartum adults with pre-existing or pregnancy-related chronic conditions.
• Intervention included default scheduling of postpartum primary care practitioner (PCP) appointments and tailored patient messaging.
• Primary outcome was PCP visit completion within 4 months postpartum, analyzed via intention-to-treat.

Main Results:

• PCP visit completion increased from 22.0% in the control group to 40.0% in the intervention group (18.7 percentage point increase).
• Intervention group showed reduced postpartum readmissions (1.7% vs. 5.8%) and increased screenings for blood pressure, weight, and depression.
• The intervention demonstrated significant improvements in primary care engagement and health service utilization.

Conclusions:

• The lack of postpartum transition support is a missed opportunity for improving maternal health.
• Behavioral economics-informed interventions, like default scheduling and tailored messages, are effective low-resource strategies.
• Reducing administrative burdens can significantly improve postpartum health and well-being for high-risk individuals.