Predicting Postpartum Transition to Primary Care in Community Health Centers

Although the transition to primary care after routine postpartum care has been recommended to mitigate adverse maternal outcomes, little is known about real-world transition patterns. The objective of this study was to describe the patterns and predictors of transition in a postpartum cohort receivi...

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Bibliographic Details
Published in:	American journal of preventive medicine Vol. 63; no. 5; pp. 689 - 699
Main Authors:	Gemkow, Jena Wallander, Liss, David T, Yang, Ta-Yun, Padilla, Roxane, King, Patricia Lee, Pereyra, Susan, Cox-Batson, Stephanie, Tenfelde, Sandi, Masinter, Lisa
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Science Ltd 01-11-2022
Subjects:	Clinical outcomes Cohort Studies Community Health Centers Community health services Completion Female Health facilities Health insurance Health services High risk Humans Inequality Medical records Medicine Mothers Patients Postpartum Period Primary care Primary Health Care Risk
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Summary:	Although the transition to primary care after routine postpartum care has been recommended to mitigate adverse maternal outcomes, little is known about real-world transition patterns. The objective of this study was to describe the patterns and predictors of transition in a postpartum cohort receiving care at federally qualified health centers and a subcohort of clinically high-risk patients. Electronic health record data collected between 2017 and 2019 were analyzed in 2021 for unadjusted analyses and multivariable regression models for both the full and high-risk cohorts. The primary outcome was completion of a primary care visit within 6 months of delivery. Primary predictors in both cohorts were insurance loss, postpartum visit, first-trimester visit, and medical visit within the year prepregnancy; for the full cohort, high-risk status was also studied. The full cohort (N=7,926) analysis showed that 17.3% completed a primary care visit. In unadjusted and adjusted analysis, all 5 predictors were significantly associated with primary care visit completion; 25.0% of high-risk patients completed a primary care visit, and patients who lost insurance had 66% lower odds of primary care visit completion (95% CI=0.24, 0.48). In unadjusted and adjusted analysis for the high-risk cohort (n=1,956, 24.7% of full cohort), all predictors except postpartum visit were significantly associated with primary care visit completion. Postpartum patients at federally qualified health centers transitioned to primary care at low rates; insurance loss was one significant barrier to care. Strategies to increase continuity, including improving insurance access, should be studied. Future research is needed to study structural inequity, the impact of primary care on maternal outcomes, and patient experience.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0749-3797 1873-2607
DOI:	10.1016/j.amepre.2022.05.010