Facilitated Transitions to Primary Care for Postpartum Individuals with Chronic Conditions

This study is looking at ways to improve healthcare for people with chronic conditions like high blood pressure (hypertension), diabetes, or anxiety after giving birth. Many people with these conditions don't get the primary care they need after delivery. This study is testing an intervention called "Facilitated Transition to Primary Care." This includes scheduling your primary care doctor (PCP) visit for you, sending you helpful messages, and sharing care recommendations with your PCP. The goal is to see if these steps help more people complete a primary care visit, get recommended health screenings, and feel like they have a reliable PCP within about five months after delivery. This study is for women aged 18 and older who are receiving obstetric care at an MGH-affiliated practice and are pregnant or have recently delivered.

Study design
This is an interventional study planning to enroll 1320 participants. It is a randomized controlled trial, meaning participants will be assigned by chance to different groups.
What's involved
Not specified in the trial record.
Compensation
Not stated in the trial record.
Follow-up
The study will measure outcomes up to 155 days (about 5 months) after your delivery date.

AI-generated from the public study record. Only the study team can confirm whether you're eligible — confirm details with them before making decisions.

NCT06557005

Facilitated Transitions From Postpartum to Primary Care Coordination for People With Chronic Conditions

Recruiting
NAAges 18+Interventional
Massachusetts General Hospital
~1,320 participants
Updated 2026-07-13 on ClinicalTrials.gov
What's tested:Facilitated Transition to Primary Care

At a glance

Recruiting sites
1 of 1 listed site is recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Completion of a primary care visit
Measured over 155 days after date of delivery
+3 more outcomes measured
Hypertension
Diabetes
Postpartum
Pregnancy
Anxiety
Depression
Obesity
1 sites across 1 states
Massachusetts1
  • Mark A Clapp, MD, MPH · PRINCIPAL_INVESTIGATOR · Massachusetts General Hospital

Opens a ready-to-send draft in your own email app — review before sending.

Do you actually qualify for this trial?

Add a private profile and we'll compare every criterion below against your situation — and tell you which ones are met, uncertain, or excluding.

Check eligibility for this trial ~2 min · HIPAA-protected · delete anytime
Eligibility criteria

Inclusion

Receiving obstetric care at an MGH-affiliated obstetrics practice (except for the MGH HOPE Clinic, which has a unique care model that provides prenatal and postnatal care for individuals with substance use disorder, including the provision of primary care through 2+ years postpartum)
Pregnant with a live fetus or delivered a live-born neonate ≥24 weeks of gestation, based on the clinical estimate of gestational age
If postpartum, has a neonate that is currently living at the time of enrollment
Has one or more of the following conditions listed in the "Problem List," "Medical History," or clinical notes during prenatal, intrapartum, or postpartum encounters in the EHR (or in the case of BMI, the patient's anthropometric measurements):
Chronic or essential hypertension
Hypertensive disorders related to pregnancy (e.g., pre-eclampsia)
Type 1 or 2 diabetes (i.e., pre-existing diabetes)
Gestational diabetes
Class II Obesity (pre-pregnancy body mass index ≥35 kg/m2; or if pre-pregnancy body mass index is not known, a first trimester BMI of ≥35 kg/m2)
Depression or anxiety disorder
Has a primary care clinician listed in the patient's medical record
Has access to or agrees to be enrolled in the electronic health record patient portal and consents to be contacted via these modalities
Able to read/speak English or Spanish language
Is age ≥18 years old
  • Completion of a primary care visit155 days after date of delivery

    Observation of a visit with a primary care practitioner (defined as physicians and advanced practice clinicians affiliated with the following medical specialties: internal medicine, family medicine, pediatrics and adolescent medicine, and gynecology).

  • Receipt of condition-specific recommended health screening and counseling by a primary care practitioner155 days after date of delivery

    For individuals with gestational hypertensive disorders, appropriate management is defined as blood pressure screening by a primary care practitioner as documented in the electronic health record. For individuals with gestational diabetes, appropriate management is defined as observation of a postpartum glucose screening testing (e.g., GTT, HgbA1c) in the electronic health record. For individuals with chronic conditions, appropriate management is defined as receipt of both condition-specific screening (mood, weight, blood pressure and/or diabetes screening) and receipt of counseling, discussion of a management, and/or referral for or acknowledgment of subspecialist management for that condition by a primary care practitioner as documented in the electronic health record. "

  • Self-report of having a known, reliable primary care practitioner155 days after date of delivery

    The outcome is the Self-report of having a known, reliable primary care practitioner (doctor, nurse practitioner, or physician's assistant).

  • Self-report of mental health155 days after date of delivery

    Edinburgh Perinatal Depression Scale will be administered and the total EPDS score compared.