Randomized Control Trial of Postpartum Visits at Two and Six Weeks.

BACKGROUND The postpartum period is critical, and women are at highest risk for perinatal complications, yet patient attendance at postpartum clinic visits is low. OBJECTIVE To determine if decreasing the time to initial postpartum (PP) visit from six weeks to two weeks can increase attendance rates at PP visits. STUDY DESIGN 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 PP visit. Secondary outcomes were emergency department (ED) visits within 30 days of delivery and non-routine clinic visits. Multivariable regression was performed to identify predictors of clinic non-attendance. To demonstrate a significant increase from the baseline clinic attendance rate of 70% to 85%, 250 participants were needed. RESULTS Between November 2018 and March 2020, 250 patients were randomized and analyzed. 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 PP visit was not significantly different among the control and intervention arms (58% vs 70%, p=0.065). 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). After adjusting for confounders, significant predictors of PP visit non-attendance included younger age, multiparity and being a patient from the high-risk obstetric clinic. 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 non-routine visits (30% vs 16%, p=0.010). In response to a patient satisfaction survey on the optimal timing of the postpartum visit, the majority (59%) of respondents would have preferred both the 2- and 6-week visit. CONCLUSION The addition of a two week postpartum visit to the six week postpartum visit did not increase the likelihood of attendance at a routine visit but did decrease the amount of urgent clinic visits.