Automated appointment scheduling and reminder messages can improve postpartum health for people with chronic conditions

Many pregnant people have chronic medical conditions, and although they are typically closely monitored during pregnancy, they often face barriers in transitioning to primary care after delivery.

a new study in JAMA network opened found that an intervention involving automated appointment scheduling and reminder messages can improve postpartum health and well-being for these individuals.

The study was led by researchers at Massachusetts General Hospital.

“Individuals with chronic and mental health conditions typically have frequent contact with obstetric providers during pregnancy, but are often largely left to fend for themselves after delivery due to ongoing care needs – often referred to as the ‘postpartum cliff,’” explains lead author Mark Clapp. MD, MPH, maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Massachusetts General Hospital and assistant professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. “Part of this ‘cliff’ is caused by administrative burdens such as scheduling appointments and navigating insurance, making it difficult for individuals to seek care.”

To address this issue, Clapp and colleagues evaluated the potential of automated appointment scheduling, along with tailored messages and push reminders, to improve primary care engagement within four months postpartum for postpartum patients with diabetes, high blood pressure, mental illness or obesity.

In the randomized clinical trial of 360 patients, those who received the intervention were more likely to have a primary care visit than those who did not, highlighting the potential of this low-cost intervention to transfer ongoing post-pregnancy care needs to primary care physicians .

Specifically, the intervention increased the number of postpartum primary care visits by 19 percentage points. It also resulted in more people receiving important screening tests and services, including blood pressure screening (42.8% vs. 28.3%), weight screening (42.8% vs. 27.7%), and screening for depression (32.8% versus 16.8%).

“Our findings indicate that a multifaceted behavioral economics intervention with relatively few resources can improve postpartum health and well-being,” Clapp said.

“As a primary care physician, I have often seen how care for individual patients is improved by careful transition between obstetrics and primary care,” said Alaka Ray, MD, a general health care practitioner and author of the study. “It’s great that this study has now demonstrated the importance of that connection in the form of significant benefits for postpartum patients with high-risk conditions.”

“I would also like to note that this study population consists of patients who already had a primary care physician. However, we all know that many others cannot find a primary care physician,” says Ray. “I hope this study will add even more urgency to the call to address the worsening primary care shortage, so that evidence-based interventions like this can be widely implemented for all our patients.”