Abstract P1172: From adverse pregnancy outcome to preventive care: insights from patient interviews on barriers to primary care after adverse pregnancy outcomes, and how to overcome them

Abstract

Introduction: Primary care is needed to assess and address cardiovascular risk after adverse pregnancy outcomes (APOs) like preeclampsia and gestational diabetes. Yet 40% of individuals with APOs do not connect with primary care post-pregnancy, a gap that is pronounced among individuals who identify as Black or have low incomes. Understanding barriers and facilitators to primary care after APOs can inform interventions to improve women’s cardiovascular health and health equity. Hypothesis: We hypothesize that patient and health system factors impede access to primary care after APOs. Methods: We conducted semi-structured interviews with individuals who experienced APOs and delivered at our urban safety-net hospital 1-2 years prior. Purposive sampling was based on patient language (English, Spanish, Haitian Creole) and linkage to primary care (yes/no) to achieve a diverse sample (goal n=30). Two researchers independently coded the transcripts using an inductive-deductive approach, informed by the Patient-Centered Access to Health Care model. Results: Recruitment was challenging; from 9/2023-8/2024 we completed 15 interviews (9 in English, 3 in Spanish, 3 in Haitian Creole) with individuals with recent APOs, all of whom had linked to primary care in the first postpartum year. Despite universal linkage, every interviewee expressed confusion or frustration with the transition from pregnancy-based care to primary care. They cited numerous patient-level barriers (e.g., competing priorities) and system-level barriers (e.g., scheduling difficulties). Figure summarizes their suggestions for improving postpartum care transitions. Conclusions: In conclusion, individuals with APOs note an abrupt and unsupported transition to primary care after pregnancy, with barriers at multiple levels. They provide concrete and actionable recommendations for health system changes to improve linkage to primary care after APOs.