Co-locating postpartum primary care with pediatrics increased timely uptake of care
New mothers who participated in a dedicated postpartum primary care clinic intervention were more likely to have a visit at four to 12 weeks postpartum than those who received usual care, and 97% of intervention patients had a primary care visit in the first year postpartum compared to 19% with usual care.
Combining postpartum visits with routine pediatric visits was associated with high rates of timely postpartum care, a study carried out at a single clinic found.
The clinic was designed to deliver co-located postpartum primary care and family planning to mothers with routine pediatric care for their infants. Care was delivered by a team of internal medicine-pediatrics primary care physicians, a psychiatrist, social workers, lactation specialists, and care navigators. Researchers compared 98 clinic and 149 usual care patients to determine if the model increased attendance at postpartum, primary care, and behavioral health visits at an academic safety-net medical center between 2020 and 2023.
Fifty-five percent of mothers identified as non-Hispanic Black, and 34% identified as Hispanic; 74% had Medicaid insurance. Those who received care from the clinic were younger on average, more likely to be primiparous, and more likely to screen positive for depression postpartum. Findings from the retrospective study were published by the Journal of General Internal Medicine on Nov. 11.
After adjustment, clinic patients had similar rates of early postpartum visits (birth to three weeks) compared with usual care (79% vs. 64%; adjusted odds ratio [aOR], 1.70 [95% CI, 0.92 to 3.14]) but were significantly more likely to have a subsequent postpartum visit (four to 12 weeks) than those who received usual care (92% vs. 79%; aOR, 2.46 [95% CI, 1.06 to 5.74]). Nearly all (97%) clinic patients visited a primary care doctor in the first year postpartum compared to 19% of the usual care group (aOR, 12.95 [95% CI, 6.80 to 24.68]). Those with behavioral health diagnoses also had higher rates of psychiatrist visits if seen at the clinic (49% vs. 13%). Documented consultation with a lactation specialist was also more common (67% vs. 15%). Seventy-seven percent of intervention patients had at least one OB/GYN visit in the first year postpartum compared with 90% of those getting usual care (aOR, 0.48 [95% CI, 0.28 to 0.85]).
One limitation to the study is that researchers were unable to determine if usual care patients were receiving primary or obstetrical care outside of the health system.
“Receiving care in a dedicated postpartum primary care clinic was associated with high rates of timely postpartum care in a group of predominantly young, racial, and ethnic minority mothers,” the study authors wrote. “The model's collaborative care and intergenerational approach potentially contributed to higher-than-expected delivery of both primary and behavioral health care services across the postpartum year compared to mothers receiving usual care.”