Improving new moms’ access to primary care helps curb ER visits
A simple intervention designed to help new mothers access primary care in the year after childbirth helped substantially reduce emergency room visits for non-emergency issues, according to a new study co-authored by researchers from Harvard T.H. Chan School of Public Health and Mass General Brigham.
The study was published May 6 in JAMA Network Open.
Co-senior author Jessica Cohen, professor of health economics, uses the term “postpartum cliff” to describe the post-birth period, when patients experience a sharp drop-off in structured care and are left to navigate a complex health system on their own. “The health system often becomes harder to navigate after delivery,” she said. “Patients must schedule new appointments, manage insurance changes, and coordinate care on their own—all while caring for a newborn and managing their own new physical and mental health needs. This kind of administrative burden can make it difficult to access timely primary care.”
As a result, many new mothers end up using hospital emergency rooms or urgent care facilities as their default care provider, even for non-emergency health issues that could be addressed in a primary care setting. These visits come at unnecessarily greater cost to the patient and the health system, and often include care that’s fragmented—with limited coordination between providers—and lower-quality.
The researchers tested the effectiveness of an intervention designed to ease the postpartum cliff, in which new mothers had their primary care visits automatically scheduled in the first four months after birth and received tailored messages and reminders about the visits and the importance of postpartum primary care. Participants included 353 pregnant or recently postpartum patients from a large academic medical center, half of whom received the intervention and half who didn’t. The researchers assessed each participant’s emergency care use over the course of a year. All of the participants had a primary care provider and had at least one comorbidity—including obesity, anxiety or depression, gestational or type 1 or 2 diabetes, or pregnancy-related or chronic hypertension—that heightened their need for health care.
The study found that 40% of participants visited an emergency room or urgent care at least once in the year following childbirth, and more than three-quarters of these visits were for concerns that are typically manageable in a primary care provider’s office, like infections, headaches, or minor illnesses. However, those who received the intervention sought emergency care for primary care-manageable concerns far less frequently than their control group counterparts. The intervention was associated with a 10-percentage-point reduction in emergency care visits for non-emergencies.
“This study demonstrates another benefit of a simple intervention that helps postpartum women reconnect with their primary care clinician,” said corresponding author Mark Clapp, a physician investigator in the Mass General Brigham Department of Obstetrics, Gynecology, and Reproductive Biology. “The finding that those who received a facilitated reconnection with their PCP had reduced urgent and emergency care visits for PCP-treated conditions suggests that these patients were turning to their PCP for non-urgent issues rather than seeking care from an urgent care facility.”
“Simplifying the transition from pregnancy to primary care—by reducing scheduling hurdles and making care easier to access—can help patients get the right care in the right place and bridge postpartum cliffs,” Cohen added. “More broadly, the study highlights an opportunity to improve how the health system supports patients during the postpartum period—a time when many fall through the cracks.”
Read the study:
Postpartum Primary Care Engagement and Acute Care Use
