Pilot Referral Program May Help Increase Postpartum Visits to Primary Care Clinicians

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Women with gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP) referred from an obstetric setting to a primary care physician (PCP) after delivery were 6-times more likely to attend a primary care visit in the first year postpartum than women who were not offered referral, according to a recent study.

Findings published in the Journal of Women’s Health also showed that women with GDM or HDP referred to a PCP were approximately twice as likely to complete cholesterol and HbA1c screenings.

Few women receive postpartum care with a PCP during the first year after delivery, which may be of particular concern for women with cardiometabolic disorders of pregnancy given their increased risk for future cardiovascular disease, according to researchers from Northwestern University Feinberg School of Medicine.

“To facilitate transitions of care to PCPs and improve cardiovascular health monitoring within the first 13 months postpartum, we developed and piloted an enhanced postpartum referral pathway for patients with GDM or HDP,” first author Natalie A. Cameron, MD, MPH, internal medicine specialist, Northwestern University Feinberg School of Medicine, and colleagues wrote.

For the pilot referral program, Cameron and colleagues assessed data from 1879 eligible individuals who met the following criteria:

• Received perinatal care at a large, urban academic medical center
• Were diagnosed with GDM or HDP during their most recent pregnancy, and
• Did not have an existing PCP

Of those eligible patients, 129 were referred to a PCP during antenatal, delivery-related, or postpartum visits by resident, faculty, or advanced practitioners. Then, a dedicated scheduler contacted participants to schedule an appointment with a women’s health-focused resident or faculty PCP.

Cameron and colleagues compared the proportion of participants with and without a referral who attended a postpartum PCP visit and had panels for HbA1c and cholesterol completed within the first 13 months postpartum.

Among the 129 women referred, 48.1% attended a PCP visit, 31.8% completed cholesterol screening, and 41.9% completed HbA1c screening within 13 months after delivery.

After researchers adjusted for age, parity, insurance, and referral indication, results showed that women who were referred, compared to nonreferred women, had higher odds of attending a PCP visit (aOR 6.0, 95% CI 4.0–9.0), receiving cholesterol screening (aOR 2.4, 95% CI 1.6-3.9), and having an HbA1c screening (aOR 2.5, 95% CI 1.7-3.7) within 13 months postpartum after researchers adjusted for age, parity, insurance, and referral indication.

Reference: Cameron NA, Birdsell H, Niznik CM, et al. An enhanced postpartum transition program to primary care. J Womens Health (Larchmt). Published online April 18, 2024. doi:10.1089/jwh.2023.0465