The Impact of a Behavioral-Economics Informed Intervention on Primary Care Utilization for Postpartum Individuals with Chronic Conditions: A Randomized Controlled Trial

Importance: Despite careful monitoring of chronic and gestational conditions during pregnancy, most postpartum individuals with (or at high risk for) chronic conditions are not engaged in primary care following delivery. This lack of postpartum obstetric-to-primary care transition reflects a missed opportunity to improve short- and long-term health and well-being. Objective: To evaluate the efficacy of a behavioral economics-informed intervention designed to reduce patient administrative burden and information gaps on postpartum primary care visit completion. Design: Individual-level randomized controlled trial. Setting: Academic obstetric practice that included hospital- and community-based outpatient clinics. Participants: English- and Spanish-speaking pregnant or recently postpartum adults who had obesity (pre-pregnancy body mass index (>=30 kg/m2)), anxiety or depressive mood disorder, type 1 or 2 diabetes mellitus, chronic hypertension, gestational diabetes, and pregnancy-related hypertension listed in their medical record were eligible to participate. Participants also were required to have a primary care clinician (PCP) listed in their electronic health record. Intervention: A behavioral economics-informed intervention bundle, which included automatic scheduling of PCP appointments after delivery, patient-tailored health information, and appointment reminder nudges. Main Outcome: Attending a "health care maintenance" (i.e., "annual exam") appointment or receiving disease-specific management relating to the eligibility criteria (obesity, anxiety/depression, diabetes, or hypertension) by a PCP within 4 months of delivery. Results: 360 patients were randomized: 176 to the control group and 184 to the intervention group. primary outcome occurred in 22.0% in the control group and 40.0% in the intervention group (p<0.001). In the regression model that accounted for the randomization strata, the intervention increased PCP visit completion within 4 months of a patient's EDD by 19.9 percentage points (95% confidence interval (CI) 10.7-29.1). Conclusions and Relevance: Standard postpartum care practice encourages but does not facilitate transitions from obstetric to primary care. This study found that a behavioral science-informed intervention designed to facilitate this transition through default PCP visit scheduling, tailored messages, and nudge reminders substantially increased postpartum primary care visit completion for patients with or at risk for common comorbidities. This intervention represents a potentially low-cost and scalable solution to increase primary care engagement and ongoing health condition management after pregnancy, a time of high engagement and health activation. Trial Registration: [NCT05543265][1]. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05543265 ### Funding Statement This study was funded by the National Institute for Aging via the MIT Roybal Center for Translational Research to Improve Health Care for the Aging (P30AG064190) and the NBER Roybal Center for Behavior Change in Health (P30AG034532). Additional support was provided by the National Academy of Medicine's Health Catalyst Award. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Mass General Brigham gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05543265&atom=%2Fmedrxiv%2Fearly%2F2024%2F01%2F22%2F2024.01.21.24301585.atom