Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
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Article Info
Publication History
Published online: July 12, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
