Primary Care Clinician Perspectives on Barriers to Postpartum Transition to Primary Care

Abstract

Background: The transition from obstetric to primary care is often suboptimal, particularly for individuals with barriers to accessing care. We aimed to understand experiences of primary care clinicians regarding provision of care and their perceptions of barriers to the transition of care in this critical period. Methods: We conducted focus groups with primary care clinicians recruited from diverse, urban health care settings, including an academic medical center, private practice, and federally qualified health centers. Groups were conducted in person or virtually (December 2019 to February 2021) using a semi-structured approach. Data were analyzed using the constant comparative method to identify themes regarding barriers to providing primary care to postpartum individuals. Results: The study included 28 primary care clinicians (26 physicians and two advanced practice providers) who participated in eight focus groups. Clinicians identified multiple barriers to the successful transition from obstetric to primary care in the postpartum period. Clinician-based barriers included the lack of a clear hand-off from the obstetric care team and limited capacity to adequately address social determinants of health. Clinician perceptions of patient-based barriers included adverse social determinants of health such as lack of childcare and financial and transportation limitations, challenges addressing ongoing health needs (such as persistence of postpartum medical conditions), and limited health care engagement. Conclusions: Our results illustrate multiple complex and interrelated challenges to providing optimal primary care during and after the postpartum period that are related to a fragmented health care system, suboptimal support for complex social needs, and insufficient communication between obstetric and primary care clinicians.

Keywords: care coordination; health communication; health disparities; postpartum care; primary care; transitions of care.