Chronic health conditions affect most older adults. Preventative medicine and risk management strategies, especially when applied earlier in life, are essential to altering the trajectory of a disease and ultimately improving health outcomes. Primary care providers (PCP) often provide most of these services, though younger adults are the least likely to receive primary care. This project leverages a period of high engagement and health activation during an individual's life (pregnancy) to nudge her toward use of primary care after the pregnancy episode. This randomized controlled trial will test the hypothesis that a behavioral science-informed intervention, incorporating defaults and salience, can increase the rates of PCP follow-up within 4 months following a delivery for individual with hypertension, diabetes, obesity. If successful, this intervention could serve as a scalable solution to increase primary care use and preventative health services in a population that currently has low rates of engagement and utilization of these services.
Individuals will be randomized with equal probability into either a treatment or control arm. The intervention combines several features designed to target reasons for low take-up of primary care among postpartum individuals. This project will leverage the potential value of defaults/opt-out, salient information, and reminders to encourage use of primary care. Individuals in both the intervention and control arms will receive information via the study institution's patient portal toward the end of the pregnancy regarding the importance and benefits of primary care in the postpartum year. This information will be similar to, but reinforcing, the information they would receive from their obstetrician about following up with their primary care physician. In addition to this initial message, individuals in the treatment arm will receive the following intervention components, developed based on recent evidence regarding behavioral science approaches to activating health behaviors: 1. Targeted messages about the importance and benefits of primary care 2. Default scheduling into a primary care appointment at approximately 3-4 months after delivery 3. Reminders about the appointment and importance of follow up primary care at 2-4 points during the postpartum period via the patient portal 4. Tailored language in the reminders based on recent evidence from behavioral science about the most effective approaches to increasing take-up. For example, messages will inform the patient that an appointment is being held for them at their doctor. 5. Salient labeling on follow-up appointments 6. Direct PCP messaging about the scheduled follow-up
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
360
Default primary care appointment scheduling
Patient-specific messages about the importance of postpartum care transition
Primary care appointment reminders
Massachusetts General Hospital
Boston, Massachusetts, United States
Rate of Primary Care Provider Visit Attendance
Any visit with 1) a primary care provider (e.g., internal medicine, family medicine, pediatrics, gynecology) and 2) receipt of "annual" or "health care maintenance" services OR disease-specific management (diabetes, hypertension, obesity, mental health)
Time frame: 4 months after the patient's estimated date of delivery
Rate of Primary Care Provider Visit Attendance
Any visit with 1) a primary care provider (e.g., internal medicine, family medicine, pediatrics, gynecology) and 2) receipt of "annual" or "health care maintenance" services OR disease-specific management (diabetes, hypertension, obesity, mental health)
Time frame: 12 months after the patient's estimated date of delivery
Rate of Visit With a Patient's Assigned Primary Care Provider for Receipt of "Annual" or "Health Care Maintenance" Services OR Disease-specific Management (Diabetes, Hypertension, Obesity, Mental Health)
Health care maintenance visit appointment with the patient's assigned primary care provider
Time frame: 4 months after the patient's estimated date of delivery
Rate of Visit With a Patient's Assigned Primary Care Provider for Receipt of "Annual" or "Health Care Maintenance" Services OR Disease-specific Management (Diabetes, Hypertension, Obesity, Mental Health)
Health care maintenance visit appointment with the patient's assigned primary care provider
Time frame: 12 months after the patient's estimated date of delivery
Rate of Visit Unscheduled Health Care Visit/Encounter by the Time of Outcome Assessment
Any visit to a urgent care or emergency room visit
Time frame: 4 months after the patient's estimated date of delivery
Rate of Visit Unscheduled Health Care Visit/Encounter
Any visit to a urgent care or emergency room visit
Time frame: 12 months after the patient's estimated date of delivery
Rate of Contraception Plan Documented by the Time of Outcome Assessment
Contraception plan documented by any provider after delivery
Time frame: 4 months after the patient's estimated date of delivery
Rate of Long-acting Contraception Use at Time of Outcome Assessment
Long-acting contraception use (implant, intrauterine device)
Time frame: 4 months after the patient's estimated date of delivery
Rate of Long-acting Contraception Use
Long-acting contraception use (implant, intrauterine device)
Time frame: 12 months after the patient's estimated date of delivery
Rate of Contraception Plan Documented
Contraception plan documented by any provider after delivery
Time frame: 12 months after the patient's estimated date of delivery
Rate of Pregestational Diabetes Screening Among Individuals With Gestational Diabetes
Postpartum diabetes screening among those diagnosed with gestational diabetes
Time frame: 4 months after the patient's estimated date of delivery
Rate of Pregestational Diabetes Screening Among Individuals With Gestational Diabetes
Postpartum diabetes screening among those diagnosed with gestational diabetes
Time frame: 12 months after the patient's estimated date of delivery
Rate of Weight Counseling Documented in the Health Record Among Those With Obesity
Weight counseling documentation among those with obesity
Time frame: 4 months after the patient's estimated date of delivery
Rate of Weight Counseling Documented in the Health Record Among Those With Obesity
Weight counseling documentation among those with obesity
Time frame: 12 months after the patient's estimated date of delivery
Rate of Blood Pressure Measurement Documented in the Health Record Among Those With or at Risk for Hypertension
Blood pressure documented in the EHR among those diagnosed within chronic or pregnancy-related hypertension
Time frame: 4 months after the patient's estimated date of delivery
Rate of Blood Pressure Measurement Documented in the Health Record Among Those With or at Risk for Hypertension
Blood pressure documented in the EHR among those diagnosed within chronic or pregnancy-related hypertension
Time frame: 12 months after the patient's estimated date of delivery
Rate of Mental Health Service Referral or Use Among Individuals With Mood or Anxiety Disorders
Clinical support services (e.g., social work, psychiatry, therapy) for individuals with mood or anxiety disorders
Time frame: 4 months after the patient's estimated date of delivery
Rate of Mental Health Service Referral or Use Among Individuals With Mood or Anxiety Disorders
Clinical support services (e.g., social work, psychiatry, therapy) for individuals with mood or anxiety disorders
Time frame: 12 months after the patient's estimated date of delivery
Rate of Antidepressant Use Among Individuals With Mood or Anxiety Disorders
New or continued antidepressant prescription use
Time frame: 4 months after the patient's estimated date of delivery
Rate of Antidepressant Use Among Individuals With Mood or Anxiety Disorders
New or continued antidepressant prescription use
Time frame: 12 months after the patient's estimated date of delivery
Rate of Antihypertensive Use Among Individuals With Hypertension
New or continued antihypertensive medication use among individuals with hypertension
Time frame: 4 months after the patient's estimated date of delivery
Rate of Antihypertensive Use Among Individuals With Hypertension
New or continued antihypertensive medication use among individuals with hypertension
Time frame: 12 months after the patient's estimated date of delivery
Rate of Medication Use for Glycemic Control Among Individuals With Diabetes
New or continued oral or subcutaneous diabetes medication use control among individuals with diabetes
Time frame: 4 months after the patient's estimated date of delivery
Rate of Medication Use for Glycemic Control Among Individuals With Diabetes
New or continued oral or subcutaneous diabetes medication use control among individuals with diabetes
Time frame: 12 months after the patient's estimated date of delivery
Rate of Assessment of Glycemic Control Among Individuals With or at Risk for Diabetes
Laboratory glucose screening test among individuals with or at risk for diabetes
Time frame: 4 months after the patient's estimated date of delivery
Rate of Assessment of Glycemic Control Among Individuals With or at Risk for Diabetes
Laboratory glucose screening test among individuals with or at risk for diabetes
Time frame: 12 months after the patient's estimated date of delivery
Rate of Patient-reported Primary Care Visit Attendance
Primary care provider visit attendance per patient report
Time frame: 4 months after the patient's estimated date of delivery
Rate of Patient-reported Primary Care Visit Attendance
Primary care provider visit attendance per patient report
Time frame: 12 months after the patient's estimated date of delivery
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