57 Randomized Control Trial of Postpartum Visits at 2 weeks and 6 weeks

Abstract

To determine if decreasing the time to initial postpartum visit (PPV) from six weeks to two weeks can increase attendance. We conducted a parallel, randomized, non-blinded trial at a publicly insured clinic comparing a single six-week postpartum visit (control) to two visits at two and six weeks postpartum (intervention). The primary outcome was attendance at one or more routine PPV. Secondary outcomes were emergency department (ED) visits within 30 days of delivery and urgent clinic visits. Multivariable regression was performed to identify predictors of clinic non-attendance. To demonstrate an increase of clinic attendance from 70% to 85%, 250 participants were needed. Between November 2018 and March 2020, 250 patients were randomized with outcome data available. The patient population had multiple comorbidities, notably obesity (53%), diabetes (30%), mental health disorders (22%) and hypertensive disorders (21%). The attendance at one or more PPV was similar among the control and intervention arms (58% vs 70%, p=0.065). (Figure 1) The 2-week visit had an attendance rate of 41% (51/125) and the 6-week visit had an attendance rate of 60% (151/250). The primary reasons for non-attendance at the 2-week appointment was never scheduling the appointment (73%), scheduling but not attending (15%) and scheduling but cancelling (12%). After adjusting for confounders, predictors of PPV non-attendance included younger age, multiparity and being a patient of the high-risk obstetric clinic. (Table 1) ED usage was similar among the control and intervention arm (8% vs 6%, p=0.635), however more patients in the control arm utilized the clinic for urgent visits (30% vs 16%, p=0.010). 59% of patients among both study groups preferred both visits. The addition of a 2-week postpartum visit to the routine 6-week postpartum visit did not increase the likelihood of attendance at a routine visit but did decrease the amount of urgent clinic visits. This visit may fulfill the role of close postpartum follow-up that patients of a medically complex obstetrics population often require.View Large Image Figure ViewerDownload Hi-res image Download (PPT)