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Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic

Abstract

Purpose We developed a postpartum transition clinic to better support women after hypertensive pregnancy. Description Our program goals were (1) early postpartum hypertension medical management, (2) patient and provider education around CVD risk, (3) transition to primary care provider (PCP) and (4) a sustainable clinical model reimbursed by private and public insurances. We focused on women immediately postpartum in this analysis. Assessment Over the course of 5 years, a racially and socioeconomically diverse population of 412 immediately postpartum women received care for one, two or more appointments. Referral diagnoses included antepartum preeclampsia (PET) 51% (210/412), postpartum preeclampsia/hypertension (PP-PET) 22.3% (92/412), preeclampsia superimposed on chronic hypertension (siPET) 10.2% (42/412), chronic hypertension (cHTN) 8.8% (37/412), and gestational hypertension (gHTN) 7.8% (31/412). Almost half of women had 2–3 visits 47.3% (195/412) with no difference by diagnosis (p = 0.18). No show rates were consistently around 25%. Acquisition of home blood pressure monitors increased from 56.8% (44/94) to 93.8% (61/65) over the 5 years (p < 0.0001). Nearly half of patients seen had antihypertensive medication adjustments 48.3% (199/412). Of those patients scheduled, 86.8% (79/91) attended a nutrition consultation. For patients with PCPs within our system, 79.5% (105/132) kept their scheduled follow up PCP appointments. Conclusion We report a postpartum transition clinic after hypertensive pregnancy. In this diverse population, patients attended 2–3 visits, incorporated home blood pressure monitoring, adjusted antihypertensive medications and initiated prevention measures such as nutrition referrals and PCP follow-up. An internist salary was sustained through billings and collections from private and public insurance.

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Acknowledgements

The authors would like to thank the Department of Medicine at Brigham and Women’s Hospital for innovation funding that supported the creation of the CMC. We would also like to specifically thank Joseph Frolkis, M.D. for his leadership and Steven Faulkner for his administrative data support. The work leading up to this manuscript did not receive any financial support of any kind. Finally, this paper has not been presented at any conferences to this day.

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Correspondence to Ann C. Celi.

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Celi, A.C., Seely, E.W., Wang, P. et al. Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic. Matern Child Health J 23, 1459–1466 (2019). https://doi.org/10.1007/s10995-019-02768-7

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  • DOI: https://doi.org/10.1007/s10995-019-02768-7

Keywords

  • Patient education
  • Obstetrics
  • Primary care
  • Hypertension
  • Cardiovascular disease
  • Care transitions