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Anthony L, Hilder A, Newcomb D, Webb KL, Best J, Stocker C, Long D. General practitioner perspectives on a shared-care model for paediatric patients post-intensive care: A cross-sectional survey. Aust Crit Care 2022:S1036-7314(22)00098-4. [DOI: 10.1016/j.aucc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/26/2022] [Accepted: 07/23/2022] [Indexed: 11/07/2022] Open
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Premji S, McDonald SW, Zaychkowsky C, Zwicker JD. Supporting healthy pregnancies: Examining variations in nutrition, weight management and substance abuse advice provision by prenatal care providers in Alberta, Canada. A study using the All Our Families cohort. PLoS One 2019; 14:e0210290. [PMID: 30615660 PMCID: PMC6322767 DOI: 10.1371/journal.pone.0210290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background Pregnancy is a critical time for fetal development, and education of women regarding healthy lifestyle choices is an important function for prenatal care providers, those that provide care to women during pregnancy. Within Canada, women choose to receive pregnancy care from one of a variety of publicly funded care providers. This study examines the association between the type of care provider(s) seen during pregnancy and the provision of advice related to nutrition, weight management and substance abuse. Methods Using data from the Alberta-based All Our Families prospective pregnancy cohort, we conducted bivariate and multivariate analyses to determine the likelihood of receiving advice related to nutrition, weight management, and substance abuse across provider(s) seen. Results Of 3341 women in our sample, 38% saw a single provider during pregnancy and 56% received care from multiple providers. Advice on nutrition was more likely to be provided across all providers, while weight management and substance abuse was less frequently and less consistently discussed. Relative to doctors in low-risk maternity clinics, midwives were most likely to provide nutrition (OR: 3.09, 95% CI: 1.19–8.01) and weight management (OR: 1.99, 95% CI: 1.13–3.50) advice to women. Conclusion Findings suggest that the type of prenatal advice received by women depends on the provider(s) seen during pregnancy. Substance abuse was least likely to be discussed across providers, suggesting important implications given recent cannabis legalization.
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Affiliation(s)
- Shainur Premji
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada
- * E-mail: (SP); (JDZ)
| | - Sheila W. McDonald
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Carol Zaychkowsky
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Jennifer D. Zwicker
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (SP); (JDZ)
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Tuominen M, Kaljonen A, Ahonen P, Mäkinen J, Rautava P. A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland. Int J Integr Care 2016; 16:1. [PMID: 27761106 PMCID: PMC5056594 DOI: 10.5334/ijic.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/22/2016] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. METHODS A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. RESULTS There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. CONCLUSIONS The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.
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Affiliation(s)
- Miia Tuominen
- PhD Student, Department of Clinical Medicine, Public Health, University of Turku and Institute for Child and Youth Research, University of Turku, FI-20014 Turun yliopisto, Turku, Finland
| | - Anne Kaljonen
- Statistician, Institute for Child and Youth Research, University of Turku, FI-20014 Turun yliopisto, Turku, Finland
| | - Pia Ahonen
- Head of Education and Research, Faculty of Health and Well-being, Turku University of Applied Sciences, Ruiskatu 8, 20760 Turku, Finland
| | - Juha Mäkinen
- Professor, Chief physician, Department of Obstetrics and Gynaecology, University of Turku and Department of Obstetrics and Gynaecology, Turku University Hospital, PO Box 52, 20521 Turku, Finland
| | - Päivi Rautava
- Professor, Chief physician of research, Public Health Department, University of Turku and Turku Clinical Research Centre, Turku University Hospital, PO Box 52, 20521 Turku, Finland
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Assessing the effect on outcomes of public or private provision of prenatal care in Portugal. Matern Child Health J 2016; 19:1574-83. [PMID: 25636645 DOI: 10.1007/s10995-015-1667-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To evaluate whether public and private prenatal care users experience similar outcomes, taking into consideration maternal pre-pregnancy social and clinical risk. We studied 7,325 women who delivered single newborns at five public maternity units in Porto, Portugal. Health behaviors and prenatal care were self-reported; pregnancy complications and delivery data were retrieved from medical files. The odds of inadequate weight gain, continuing to smoke, gestational hypertension, gestational diabetes, caesarean section, preterm birth, low birthweight, and small- and large-for-gestational-age were estimated for public and private providers using logistic regression, stratified by pre-pregnancy risk profile, adjusted for maternal characteristics. 38 % of women used private prenatal care. Among low-risk women, public care users were more likely to gain excessive weight (OR 1.26; 95 % CI 1.06-1.57) and be diagnosed with gestational diabetes (OR 1.37; 95 % CI 1.01-1.86). They were less likely to have a caesarean (OR 0.63; 95 % CI 0.51-0.78) and more likely to deliver small-for-gestational-age babies (OR 1.48; 95 % CI 1.19-1.83). Outcomes were similar in high-risk women although preterm and pre-labor caesarean were less frequent in public care users (OR 0.64 95 % CI 0.45-0.91; OR 0.69 95 % CI 0.49-0.97). The amount of care was not significantly related to risk profile in either case. Public care users experienced similar outcomes to those using private care, despite higher pre-pregnancy disadvantage. Low-risk women need further attention if narrowing inequalities in birth outcomes remains a priority.
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Caseload midwifery as organisational change: the interplay between professional and organisational projects in Denmark. BMC Pregnancy Childbirth 2015; 15:121. [PMID: 26013394 PMCID: PMC4493809 DOI: 10.1186/s12884-015-0546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/05/2015] [Indexed: 11/21/2022] Open
Abstract
Background The large obstetric units typical of industrialised countries have come under criticism for fragmented and depersonalised care and heavy bureaucracy. Interest in midwife-led continuity models of care is growing, but knowledge about the accompanying processes of organisational change is scarce. This study focuses on midwives’ role in introducing and developing caseload midwifery. Sociological studies of midwifery and organisational studies of professional groups were used to capture the strong interests of midwives in caseload midwifery and their key role together with management in negotiating organisational change. Methods We studied three hospitals in Denmark as arenas for negotiating the introduction and development of caseload midwifery and the processes, interests and resources involved. A qualitative multi-case design was used and the selection of hospitals aimed at maximising variance. Ten individual and 14 group interviews were conducted in spring 2013. Staff were represented by caseload midwives, ward midwives, obstetricians and health visitors, management by chief midwives and their deputies. Participants were recruited to maximise the diversity of experience. The data analysis adopted a thematic approach, using within- and across-case analysis. Results The analysis revealed a highly interdependent interplay between organisational and professional projects in the change processes involved in the introduction and development of caseload midwifery. This was reflected in three ways: first, in the key role of negotiations in all phases; second, in midwives’ and management’s engagement in both types of projects (as evident from their interests and resources); and third in a high capacity for resolving tensions between the two projects. The ward midwives’ role as a third party in organisational change further complicated the process. Conclusions For managers tasked with the introduction and development of caseload midwifery, our study underscores the importance of understanding the complexity of the underlying change processes and of activating midwives’ and managers’ interests and resources in addressing the challenges. Further studies of female-dominated professions such as midwifery should offer good opportunities for detailed analysis of the deep-seated interdependence of professional and organisational projects and for identifying the key dimensions of this interdependence.
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Brock E, Charlton KE, Yeatman H. Identification and evaluation of models of antenatal care in Australia--a review of the evidence. Aust N Z J Obstet Gynaecol 2014; 54:300-11. [PMID: 24708182 DOI: 10.1111/ajo.12210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 03/08/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antenatal care has been routine practice throughout the world since early in the 20th century, and in most developed countries, antenatal care consists of a scheduled program of individual consultations with a healthcare practitioner, using a doctor or midwife. Women seek antenatal care that provides a physical review of the health and development of their unborn baby, the reassurance and ability to be listened to and the opportunity for their partner to be involved in their care. AIMS To identify the types of antenatal care services that are available to Australian women and investigate the views and opinions of Australian women related to these services. MATERIALS AND METHODS A systematic literature review using Scopus and Medline databases was used to find appropriate journal articles in January 2013. Articles were restricted to those in the Australian setting from the past 10 years with a focus on different models of antenatal care and the views and experiences of women during their antenatal care. RESULTS Eighteen relevant peer-reviewed journal articles were included. Emerging forms of antenatal care that are showing increasing levels of satisfaction from Australian women include continuity of carer, the midwifery-led care and group- or community-led care. These approaches are proving to be safe and successful. CONCLUSION Newer models of antenatal care in Australia may offer benefits over standard practice.
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Affiliation(s)
- Erin Brock
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Metcalfe A, Grabowska K, Weller C, Tough SC. Impact of prenatal care provider on the use of ancillary health services during pregnancy. BMC Pregnancy Childbirth 2013; 13:62. [PMID: 23497179 PMCID: PMC3599935 DOI: 10.1186/1471-2393-13-62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/01/2013] [Indexed: 11/15/2022] Open
Abstract
Background Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. Methods Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. Results During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. Conclusions Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology, University of British Columbia, BC Women’s and Children’s Hospital, 4500 Oak St, Vancouver, BC V6H 3N1, Canada
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Does the organizational model of the maternity health clinic have an influence on women's and their partners' experiences? A service evaluation survey in Southwest Finland. BMC Pregnancy Childbirth 2012; 12:96. [PMID: 22974077 PMCID: PMC3520862 DOI: 10.1186/1471-2393-12-96] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 08/30/2012] [Indexed: 11/25/2022] Open
Abstract
Background In high-income countries, great disparities exist in the organizational characteristics of maternity health services. In Finland, primary maternity care is provided at communal maternity health clinics (MHC). At these MHCs there are public health nurses and general practitioners providing care. The structure of services in MHCs varies largely. MHCs are maintained independently or merged with other primary health care sectors. A widely used organizational model of services is a combined maternity and child health clinic (MHC & CHC) where the same public health nurse takes care of the family from pregnancy until the child is at school age. The aim of this study was to determine how organizational model, MHC independent or combined MHC & CHC, influence on women’s and their partners’ service experiences. Methods A comparative, cross-sectional service evaluation survey was used. Women (N = 995) and their partners (N = 789) were recruited from the MHCs in the area of Turku University Hospital. Four months postpartum, the participants were asked to evaluate the content and amount of the MHC services via a postal questionnaire. Comparisons were made between the clients of the separate MHCs and the MHCs combined to the child health clinics. Results Women who had used the combined MHC & CHCs generally evaluated services more positively than women who had used the separate MHCs. MHC’s model was related to several aspects of the service which were evaluated “good” (the content of the service) or “much” (the amount of the service). Significant differences accumulated favoring the combined MHC & CHCs’ model. Twelve aspects of the service were ranked more often as “good” or “much” by the parents who had used the combined MHC & CHC, only group activities regarding delivery were evaluated better by women who had used the separate MHCs. Conclusions Based on the women’s and partners’ experiences an organizational model of the combined MHC & CHC where the same nurse will take care of family during pregnancy and after birth of the child was preferred. This model also provides greater amount of home visits and peer support than the separate MHC.
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Stacey T, Thompson JMD, Mitchell EA, Zuccollo JM, Ekeroma AJ, McCowan LME. Antenatal care, identification of suboptimal fetal growth and risk of late stillbirth: findings from the Auckland Stillbirth Study. Aust N Z J Obstet Gynaecol 2012; 52:242-7. [PMID: 22276935 DOI: 10.1111/j.1479-828x.2011.01406.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 12/05/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stillbirth remains an important public health problem in Australia and New Zealand. The role that antenatal care plays in the prevention of stillbirth in high-income countries is unclear. METHODS Cases were women with a singleton, late stillbirth without congenital abnormality, booked to deliver in the Auckland region and born between July 2006 and June 2009. Two controls with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Data were collected through interview-administered questionnaires and from antenatal records. RESULTS One hundred and fifty five of 215 (72%) cases and 310 of 429 (72%) controls consented to take part in the study. Accessing <50% of recommended antenatal visits was associated with a more than twofold increase in late stillbirth (adjusted odds ratio, aOR, 2.68; 95% CI, 1.04-6.90) compared with accessing the recommended number of visits. Small-for-gestational-age (SGA) babies that had not been identified as SGA prior to birth were significantly more at risk of being stillborn (aOR, 9.46; 95% CI, 1.98-45.13) compared with SGA babies that were identified as such in the antenatal period. No relationship was found between type or model of maternity care provider at booking and late stillbirth risk. DISCUSSION This study reinforces the importance of regular antenatal care attendance. Identification of SGA may be one way by which antenatal care reduces stillbirth.
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Affiliation(s)
- Tomasina Stacey
- Department of Obstetrics and Gynaecology, University of Auckland, Grafton, Auckland, New Zealand.
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Chin GSM, Warren N, Kornman L, Cameron P. Patients' perceptions of safety and quality of maternity clinical handover. BMC Pregnancy Childbirth 2011; 11:58. [PMID: 21827711 PMCID: PMC3167750 DOI: 10.1186/1471-2393-11-58] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care. Methods This paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA. Results Almost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA), shared decision making and patient motivation in labour. Conclusions This study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and communication. Cross-checking and cognitive artefacts were observed to support handover. Patient-authored birth plans were described by some to enhance the quality and safety of the handover by providing a 'voice' to the patient in this process. This was a novel and potentially important perspective. Future research involving patients and their support people in supporting and evaluating handover should be considered.
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Affiliation(s)
- Georgiana S M Chin
- Centre for Research Excellence in Patient Safety, Department of Epidemiology and Preventive Medicine, Monash University, Australia.
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