Postpartum Primary Care Engagement and Acute Care Use: Secondary Analysis of a Randomized Clinical Trial.

Abstract

Patients are often monitored closely during pregnancy, then face barriers to transitioning to primary care after delivery. These barriers may contribute to a reliance on acute care for primary care-treatable concerns. To evaluate the association of an intervention that increased postpartum primary care engagement over the first year after delivery with overall acute care (emergency department [ED] and urgent care center [UC]) use and acute care use for primary care-treatable concerns (ie, nonemergency conditions or conditions typically managed by a primary care practitioner [PCP]). This is a nonprespecified secondary analysis of a randomized clinical trial (RCT) conducted from November 3, 2022, to October 11, 2023, at 1 hospital-based clinic and 5 community-based obstetric clinics at a large academic medical center. The 353 participants included English- and Spanish-speaking pregnant or recently postpartum adults with 1 or more comorbidities and an assigned PCP. This behavioral science-informed intervention included default scheduling of postpartum PCP appointments within 4 months post partum and tailored messages and reminders about the appointments and the importance of postpartum primary care. Main outcomes included the use of any acute care and the number of acute care visits during the postpartum period, as well as the use of acute care and the number of visits specifically for primary care-treatable concerns (based on the reason for visit). Ordinary least-squares regression, adjusted for randomization strata and patient demographic and health characteristics, was used to assess the association of the intervention with the use of acute care. Outcomes were analyzed using an intent-to-treat approach. A total of 353 patients (mean [SD] age, 34.1 [4.9] years) were enrolled in the RCT (control, 173 [49.0%]; intervention, 180 [51.0%]). The intervention had no statistically significant association with overall postpartum acute care use, but it was associated with decreased acute care use for primary care-treatable concerns (control, 70 of 173 [40.5%]; intervention, 53 of 180 [29.4%]); in the adjusted model, the intervention was associated with in a 10.2-percentage point reduction in these visits (95% CI, -20.4 to -0.04 percentage points). The intervention was also associated with a reduced number of visits for primary care-treatable concerns (control: mean [SD], 0.7 [1.1] visits; intervention: mean [SD], 0.4 [0.8] visits), corresponding to a reduction of 0.3 visits (95% CI, -0.5 to -0.1 visits) in the adjusted model. In this secondary analysis of an RCT, a behavioral science-informed intervention that increased postpartum primary care engagement was associated with decreased acute care use for primary care-treatable concerns. The results suggest that supporting postpartum transitions to primary care may reduce reliance on acute care, perhaps by facilitating greater care coordination and early detection and management of chronic conditions in the primary care setting. ClinicalTrials.gov Identifier: NCT05543265.