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BMC Pregnancy and Childbirth Jul 2016Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread... (Review)
Review
BACKGROUND
Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.
METHODS
A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.
RESULTS
From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.
CONCLUSIONS
The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.
Topics: Australia; Canada; China; Female; Humans; Infant, Newborn; Ireland; Maternal-Child Health Services; Mexico; Midwifery; Models, Theoretical; Pregnancy; Prenatal Care; Quality Assurance, Health Care; Randomized Controlled Trials as Topic; Sweden; United Kingdom
PubMed: 27430506
DOI: 10.1186/s12884-016-0944-6 -
Cadernos de Saude Publica Jun 2015This cross-sectional study intended to assess the use of prenatal care according to the family structure in a population with free universal access to prenatal care. In...
This cross-sectional study intended to assess the use of prenatal care according to the family structure in a population with free universal access to prenatal care. In 2005-2006, the Portuguese birth cohort was assembled by the recruitment of puerperae at public maternity wards in Porto, Portugal. In the current analysis, 7,211 were included. Data on socio-demographic characteristics, obstetric history, and prenatal care were self-reported. Single mothers were considered as those whose household composition did not include a partner at delivery. Approximately 6% of the puerperae were single mothers. These women were more likely to have an unplanned pregnancy (OR = 6.30; 95%CI: 4.94-8.04), an inadequate prenatal care (OR = 2.30; 95%CI: 1.32-4.02), and to miss the ultrasound and the intake of folic acid supplements during the first trimester of pregnancy (OR = 1.71; 95%CI: 1.30-2.27; and OR = 1.67; 95%CI: 1.32-2.13, respectively). The adequacy and use of prenatal care was less frequent in single mothers. Educational interventions should reinforce the use and early initiation of prenatal care.
Topics: Adult; Cross-Sectional Studies; Family Characteristics; Female; Health Knowledge, Attitudes, Practice; Humans; Portugal; Pregnancy; Prenatal Care; Risk Factors; Single Person; Single-Parent Family; Socioeconomic Factors
PubMed: 26200376
DOI: 10.1590/0102-311X00052114 -
Annals of Internal Medicine May 2019Studies show that patients want to engage in cost-of-care conversations and factor costs into the formulation of care plans. Low-income patients are particularly likely...
BACKGROUND
Studies show that patients want to engage in cost-of-care conversations and factor costs into the formulation of care plans. Low-income patients are particularly likely to defer care because of costs, suggesting that cost-of-care conversations may be an important factor in health equity. Little guidance is available to clinicians and health systems for how to integrate effective cost-of-care conversations into clinical practice or to address specific cost needs of low-income patients.
OBJECTIVE
To develop a framework and tool to assist cost-of-care conversations with low-income patients during prenatal care.
DESIGN
A qualitative study using human-centered design methods.
SETTING
University medical center-based obstetrics-gynecology (ob-gyn) practice.
PARTICIPANTS
20 pregnant or recently postpartum women, 16 clinicians, and 8 support and executive staff.
RESULTS
Pregnant women accumulate substantial indirect costs that interfere with treatment adherence and stress patients and their relationships. Frequency and duration of appointments are primary drivers of indirect costs; the burden is exacerbated by not knowing these costs in advance and disproportionately affects low-income patients. Working with ob-gyn clinicians, staff, and patients, a paper-based tool was developed to help patients forecast treatment demands and indirect costs, and to help clinicians introduce and standardize cost conversations.
LIMITATIONS
Data were collected from a small number of stakeholders in a single clinical setting that may not be generalizable to other settings. The tool has not been tested for effects on adherence or clinical outcomes.
CONCLUSION
A communication tool that helps pregnant patients understand their care plan and anticipate indirect costs can promote cost-of-care conversations between clinicians and low-income patients.
PRIMARY FUNDING SOURCE
Robert Wood Johnson Foundation.
Topics: Communication; Female; Health Expenditures; Humans; Office Visits; Physician-Patient Relations; Poverty; Pregnancy; Prenatal Care; Qualitative Research; Stakeholder Participation; United States
PubMed: 31060059
DOI: 10.7326/M18-2207 -
BMC Medicine Dec 2016The global health community is currently transitioning from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Unfortunately, progress...
BACKGROUND
The global health community is currently transitioning from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Unfortunately, progress towards maternal, newborn and infant health MDGs has lagged significantly behind other key health goals, demanding a renewed global effort in this key health area. The World Health Organization and other institutions heralded integrated antenatal care (ANC) as the best way to address the inter-related health issues of HIV, tuberculosis (TB) and malaria in the high risk groups of pregnant women and infants; integrated ANC services also offer a mechanism to address slow progress towards improved maternal health.
DISCUSSION
There is remarkably limited evidence on best practice approaches of program implementation, acceptability and effectiveness for integrated ANC models targeting multiple diseases. Here, we discuss current integrated ANC global guidelines and the limited literature describing integrated ANC implementation and evidence for their role in addressing HIV, malaria and TB during pregnancy in sub-Saharan Africa. We highlight the paucity of data on the effectiveness of integrated ANC models and identify significant structural barriers in the health system (funding, infrastructure, distribution, human resources), the adoption system (limited buy-in from implementers, leadership, governance) and, in the broader context, patient-centred barriers (fear, stigma, personal burdens) and barriers in funding structures. We highlight recommendations for action and discuss avenues for the global health community to develop systems to integrate multiple disease programs into ANC models of care that better address these three priority infectious diseases. With the current transition to the SDGs and concerns regarding the failure to meet maternal health MDGs, the global health community, researchers, implementers and funding bodies must work together to ensure the establishment of quality operational and implementation research to inform integrated ANC models. It is imperative that the global health community engages in a timely discussion about such implementation innovations and instigates appropriate actions to ensure advances in maternal health are sufficient to meet applicable SDGs.
Topics: Africa South of the Sahara; Female; Goals; HIV Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Malaria; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Prenatal Care; Tuberculosis; World Health Organization
PubMed: 27938369
DOI: 10.1186/s12916-016-0753-9 -
Midwifery May 2024Antenatal care guidelines used in Australia are inconsistent in their recommendations for childbirth and parenting education (CBPE) classes for preparation of women and... (Review)
Review
PROBLEM
Antenatal care guidelines used in Australia are inconsistent in their recommendations for childbirth and parenting education (CBPE) classes for preparation of women and parents for pregnancy, childbirth, and early parenting.
BACKGROUND
Clinical practice guidelines in maternity care are developed to assist healthcare practitioners and consumers to make decisions about appropriate care. The benefit of such guidelines relies on the translation and quality of the evidence contained within them. In the context of antenatal care guidelines, there is a potential evidence-practice gap with regard to CBPE.
AIMS
This review aims to appraise the quality of Australian antenatal care guidelines in their recommendations for CBPE for women and partners.
METHODS
Publicly available Australian antenatal care guidelines were identified including local health district websites and professional organisations pertaining to maternity care. Guidelines were reviewed independently, and the quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
FINDINGS
Five guidelines were included in the review and appraised using AGREE II. With the exception of the Department of Health Pregnancy Care Guidelines, guidelines scored poorly across all six domains. When appraised according to specific CBPE recommendations for rigour of development, presentation, and applicability; all guidelines received low scores.
DISCUSSION
Prenatal services remain largely unregulated across the board, with no systematic approach to make recommendations for CBPE and guidelines lacking in rigour with regard to CBPE.
CONCLUSION
Within the guidelines reviewed there was a lack of evidence-based recommendations provided for educators or consumers regarding childbirth and parenting education.
Topics: Humans; Pregnancy; Female; Australia; Prenatal Education; Prenatal Care; Practice Guidelines as Topic
PubMed: 38461784
DOI: 10.1016/j.midw.2024.103960 -
Journal of Pregnancy 2018Innovative models of prenatal care are needed to improve pregnancy outcomes and lower the cost of care. We sought to increase the value of traditional prenatal care by...
OBJECTIVE
Innovative models of prenatal care are needed to improve pregnancy outcomes and lower the cost of care. We sought to increase the value of traditional prenatal care by using a new model (PodCare) featuring a standardized visit schedule and coordination of care within small interdisciplinary teams in an academic setting.
METHODS
Prenatal providers and clinic staff were divided into four "Pods". Testing and counseling topics were assigned to visits based on gestational age. Interdisciplinary weekly Pod meetings provided coordination of care. A retrospective chart review was performed. The primary endpoints were the number of prenatal care visits and number of providers seen.
RESULTS
After PodCare implementation, more patients choose care with the low-risk physician team (42% compared to 26%). Study subjects included 85 women in 2013 and 165 women in 2014. The median number of visits decreased from 13 to 10 (p < 0.00004) and the median number of providers seen decreased from 7 to 5 (p < 0.0000008).
CONCLUSION
PodCare increased the value of individual prenatal care by decreasing the number of visits, increasing continuity, and providing care coordination. The model provides a robust experience in interdisciplinary care. The PodCare model may be successful at other academic institutions.
Topics: Ambulatory Care; Cohort Studies; Comprehensive Health Care; Female; Health Personnel; Humans; Interdisciplinary Communication; Patient Care Team; Pregnancy; Pregnancy Outcome; Prenatal Care; Quality of Health Care; Retrospective Studies
PubMed: 30310700
DOI: 10.1155/2018/3515302 -
JMIR MHealth and UHealth May 2019Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to...
BACKGROUND
Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction.
OBJECTIVE
The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction.
METHODS
This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care.
RESULTS
A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group.
CONCLUSIONS
The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517).
Topics: Adult; District of Columbia; Female; House Calls; Humans; Mobile Applications; Parenting; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Prenatal Care; Prospective Studies
PubMed: 31042154
DOI: 10.2196/10520 -
Nursing ResearchAmong Black Americans, interpersonal racial discrimination is common. Stress, including following discrimination, contributes to pregnancy complications. In this...
BACKGROUND
Among Black Americans, interpersonal racial discrimination is common. Stress, including following discrimination, contributes to pregnancy complications. In this secondary analysis, we provide data on associations among discrimination, stress, and their interaction across the life course and inflammation, perceived stress, and depressive symptoms during pregnancy.
METHODS
During the early third trimester, Black American women (n = 93) completed the Experiences of Discrimination Scale, the Stress and Adversity Inventory, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Inventory. Plasma interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), and IL-β levels were quantified. Associations were examined by linear regression, controlling for demographic, behavioral, and clinical covariates.
RESULTS
Associations among racial discrimination and plasma IL-8, TNF-α, and IL-β levels depended upon average ratings of life course stress. When stress was low, discrimination in the mid tertile was associated with the highest levels of IL-8, TNF-α, and IL-β. Subscale analyses suggested that findings related to IL-8 were driven by chronic stress whereas findings related to TNF-α and IL-β were driven by acute stress. When examined together, greater discrimination but not greater life course stress was associated with higher prenatal perceived stress. In subscale analyses, the association between discrimination and prenatal perceived stress depended upon average ratings of life course acute stress. When acute stress was low, discrimination in the midtertile was associated with the highest levels of prenatal perceived stress. When acute stress was high, discrimination in the high tertile was associated with the highest levels of prenatal perceived stress. There were also direct associations among greater life course chronic stress, prenatal perceived stress, and prenatal depressive symptoms. Associations were attenuated when discrimination was included as a covariate.
CONCLUSIONS
The current analyses suggest that, among Black Americans, prenatal inflammation, perceived stress, and depressive symptoms may be shaped by racial discrimination and stress across the life course. In many cases, associations among discrimination and prenatal parameters depended upon how stressful exposures to life course stressors had been rated. The data suggest the potential for adaptive plasticity under some stress and highlight the deleterious nature of compounding stress.
Topics: Adolescent; Adult; Black or African American; Depression; Female; Humans; Inflammation; Linear Models; Male; Pregnancy; Pregnancy Complications; Prenatal Care; Racism; Socioeconomic Factors; Stress, Psychological
PubMed: 34173372
DOI: 10.1097/NNR.0000000000000525 -
BJOG : An International Journal of... Sep 2020To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak.
OBJECTIVES
To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak.
DESIGN
Cross-sectional study.
SETTING
Two cities in China--Wuhan (epicentre) and Chongqing (a less affected city).
POPULATION
A total of 1947 pregnant women.
METHODS
We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis.
MAIN OUTCOME MEASURES
Anxiety status and its influencing factors. Obstetric decision-making.
RESULTS
Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding.
CONCLUSIONS
The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics.
TWEETABLE ABSTRACT
The COVID-19 outbreak increased pregnant women's anxiety and affected their decision-making.
Topics: Adult; Anxiety; Betacoronavirus; COVID-19; China; Coronavirus Infections; Cross-Sectional Studies; Delivery, Obstetric; Diagnostic Self Evaluation; Female; Humans; Pandemics; Pneumonia, Viral; Pregnancy; Pregnancy Complications; Pregnant Women; Prenatal Care; Qualitative Research; SARS-CoV-2
PubMed: 32583536
DOI: 10.1111/1471-0528.16381 -
Epidemiologia E Servicos de Saude :... 2020to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the...
OBJECTIVE
to describe the adequacy of primary health care center structure, requests for tests and prenatal care reported by female health service users within the scope of the Program for Improving Primary Care Access and Quality (PMAQ) in Brazil.
METHODS
this was a cross-sectional study using PMAQ Cycle II (2014) data.
RESULTS
data from 9,909 health centers, 9,905 teams, and 9,945 female health service users were included; 70.1% (95%CI 69.2;71.0) of health centers had adequate structure; 88.0% (95%CI 87.4;88.7) of the teams requested all tests; 59.8% (95%CI 58.8;60.8) of female health service users reported receiving total guidance, and 23.4% of them (95%CI 22.5;24.2) underwent all physical examination procedures; teams that participated in both Cycle I and Cycle II presented better results.
CONCLUSION
in spite of shortcomings in Primary Care structure and work process in Brazil, PMAQ appears to positively affect prenatal care.
Topics: Brazil; Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Patient Care Team; Pregnancy; Prenatal Care; Primary Health Care; Quality of Health Care
PubMed: 32074198
DOI: 10.5123/S1679-49742020000100008