Bridging the Gap to Primary Care: A Behavioral Science Informed Intervention to Improve Chronic Disease Management among Postpartum Women

Primary care providers (PCPs) are essential for prevention and management of chronic diseases across the lifespan. Despite the substantial role of chronic diseases in death and disability in the US, PCP use has been declining. Although chronic conditions are more common in old age, a range of conditions—including diabetes, hypertension, obesity and mental illness—are often detected during pregnancy. Further, certain pregnancy-related conditions increase the risk of developing chronic conditions later in life. The postpartum period is a crucial window for managing these conditions and positioning women toward longer-term health and wellbeing. However, very few postpartum women at risk for long-term disease receive any primary care. Postpartum women with diabetes, obesity, hypertension and mental illness are largely unsupported in transitions to primary care—many are simply told to follow up with their PCP without relevant information, scheduling assistance, or official transfer of accountability across providers. Our project explores the drivers of these postpartum care “cliffs” and tests new approaches to increasing PCP use for postpartum women with high-priority conditions. We will conduct a randomized controlled trial testing a behavioral-science inspired intervention package on PCP use for postpartum women with long-term disease risk. The intervention incorporates best practice from behavioral economics on catalyzing health behaviors, including defaults, nudges and salient, timely information. We will also conduct a longitudinal survey with postpartum women to trace out the barriers and facilitators of primary care use. Our goal is to identify health policy, health system, and provider-level approaches to improving postpartum care continuity.