Divisions of Maternal-Fetal Medicine and Cardiology, University of Pennsylvania Perelman School of Medicine, and the Department of Obstetrics & Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania; and the Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, Michigan.
Obstet Gynecol. 2023 Jul 1;142(1):91-98. doi: 10.1097/AOG.0000000000005237. Epub 2023 Jun 7.
Scalable interventions are needed to improve preventive care for those with increased cardiovascular disease (CVD) risk identified during pregnancy. We hypothesized that an automated reminder message for clinicians (nudge) would increase counseling at the postpartum visit on patient transitions of care.
We conducted a single-center, randomized controlled trial including birthing people with a hypertensive disorder of pregnancy evaluating a nudge compared with usual care. The nudge, including counseling phrases and patient-specific information on hypertensive diagnosis, was sent to the obstetric clinician through the electronic medical record up to 7 days before the postpartum visit. The primary outcome was documentation of counseling on transitions of care to primary care or cardiology. Secondary outcomes were documentation of CVD risk, use of counseling phrases, and preventive care visit within 6 months. A sample size of 94 per group (n=188) was planned to compare the nudge intervention with usual care; given the anticipated loss to follow-up, the sample size was increased to 222. Intention-to-treat analyses were performed, with P <.05 considered significant.
From February to June 2021, 392 patients were screened, and 222 were randomized and analyzed. Of these, 205 (92.3%) attended a postpartum visit. Groups were similar, but more women in the usual care group had diabetes (16.1% vs 6.7%, P =.03). After adjustment for diabetes, patients in the nudge group were more likely to have documented counseling on transitions of care (38.8% vs 26.2%, adjusted relative risk [aRR] 1.53, 95% CI 1.02-2.31), CVD risk (21.4% vs 8.4%, aRR 2.57, 95% CI 1.20-5.49), and use of aspirin in a future pregnancy (14.3% vs 1.9%, aRR 7.49, 95% CI 1.66-33.93). Counseling phrases were used more often in the nudge group (11.2% vs 0.9%, aRR 12.27, 95% CI 1.50-100.28). Preventive care visit attendance did not differ by group (22.1% vs 24.6%, aRR 0.91, 95% CI 0.57-1.47).
A timely electronic reminder to obstetric clinicians improved counseling about transitions of care after hypertensive disorders of pregnancy but did not result in increased preventive care visit attendance.
ClinicalTrials.gov , NCT04660032.
需要可扩展的干预措施来改善在怀孕期间发现心血管疾病（CVD）风险增加的人群的预防保健。我们假设，为临床医生提供自动提醒信息（即“推动”）将增加产后就诊时关于患者过渡护理的咨询。
我们进行了一项单中心、随机对照试验，纳入了患有妊娠高血压疾病的分娩人群，评估了推动与常规护理的效果。推动措施包括通过电子病历在产后就诊前最多提前 7 天向产科临床医生发送咨询短语和患者特定的高血压诊断信息。主要结局是记录向初级保健或心脏病学过渡护理的咨询情况。次要结局是记录 CVD 风险、使用咨询短语和在 6 个月内进行预防保健就诊的情况。计划每组 94 人（n=188）进行比较，考虑到预期的随访损失，样本量增加到 222 人。采用意向治疗分析，P<.05 认为有统计学意义。
2021 年 2 月至 6 月期间，共筛选了 392 名患者，随机分配并分析了 222 名患者。其中，205 名（92.3%）参加了产后就诊。两组患者相似，但常规护理组中更多的女性患有糖尿病（16.1%比 6.7%，P=.03）。调整糖尿病因素后，推动组患者更有可能记录到关于过渡护理的咨询（38.8%比 26.2%，调整后相对风险 [aRR] 1.53，95%置信区间 [CI] 1.02-2.31），CVD 风险（21.4%比 8.4%，aRR 2.57，95% CI 1.20-5.49），以及在未来妊娠中使用阿司匹林（14.3%比 1.9%，aRR 7.49，95% CI 1.66-33.93）。推动组更常使用咨询短语（11.2%比 0.9%，aRR 12.27，95% CI 1.50-100.28）。两组的预防保健就诊率没有差异（22.1%比 24.6%，aRR 0.91，95% CI 0.57-1.47）。
及时向产科临床医生发送电子提醒可改善妊娠高血压疾病后关于过渡护理的咨询，但并未增加预防保健就诊率。
ClinicalTrials.gov ，NCT04660032。
