A clinical trial found that default scheduling and tailored messages increased postpartum primary care visit rates by 19 percentage points.
The trial examined the effect of a behavioral economic intervention on postpartum primary care engagement. The study, published in JAMA Network Open, aimed to mitigate patient administrative burden and information gaps to improve primary care practitioner (PCP) visit completion among postpartum patients.
The trial enrolled 360 postpartum patients with or at risk for chronic conditions, randomizing them into a control group (n=176) or an intervention group (n=184). The mean age of participants was 34.1 years (standard deviation, 4.9 years). The median gestational age was 36.3 weeks (interquartile range, 34.0-38.6 weeks). The race and ethnicity distribution was 6.8% Asian, 7.4% Black, 68.6% White, and 15.0% multiple races or other. Anxiety or depression was reported by 75.4% of participants; chronic or pregnancy-related hypertensive disorder was present in 16.1%; pre-existing or gestational diabetes was reported by 19.5%; a prepregnancy body mass index of 30 or greater was noted in 40.8%; and Medicaid was the primary payer for 21.2%.
This individual-level randomized clinical trial was conducted from November 3, 2022, to October 11, 2023, across one hospital-based and five community-based outpatient obstetric clinics affiliated with a large academic medical center. Participants included English- and Spanish-speaking adults with obesity, anxiety, depression, diabetes, chronic hypertension, gestational diabetes, or pregnancy-related hypertension.
The intervention group received default PCP scheduling, tailored messages, and reminders. The behavioral economics–informed intervention included automatic scheduling of postpartum PCP appointments, custom messages emphasizing the importance of PCP visits, and appointment reminders sent approximately 1 month after the estimated due date and 1 week before the scheduled appointment.
The intervention increased PCP visit completion rates by 19 percentage points, from 22.0% (95% confidence interval [CI], 6.4%-28.8%) in the control group to 40.0% (95% CI, 33.1%-47.4%) in the intervention group. Patients in the intervention group were more likely to receive blood pressure screening (42.8% vs. 28.3%), weight assessment (42.8% vs. 27.7%), and depression screening (32.8% vs. 16.8%) than those in the control group. The intervention group also had fewer postpartum readmissions (1.7% vs. 5.8%).
The findings indicated that reducing administrative burdens through default scheduling and tailored messaging may improve postpartum primary care engagement.
Full disclosures can be found in the published study.