Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial

BMC Health Services Research

Belinda Lovell¹  Bree Rankin⁴  Jane Yelland⁵  Jo Rayner²  Tanya Farrell¹  Lisa Gold⁶  Helen L McLachlan²  Tracey L Savage³  Della A Forster¹ 

[1] The Royal Women’s Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville 3052, Australia;School of Nursing and Midwifery, La Trobe University, Melbourne Campus, Kingsbury Drive, Bundoora 3086, Vic, Australia;Yale New Haven Hospital, 20 York Street, New Haven 06510, CT, USA;Drug Strategy Analysis Unit, Population 846 Health Division, Department of Health and Ageing, Canberra, Australia;Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville 3052, Victoria, Australia;Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood 3125, Australia

关键词: Postnatal preparation;    Early discharge;    Individualised care;    Domiciliary care;    Postnatal care;   

Others  :  1091071
DOI  :  10.1186/s12913-014-0569-2

 received in 2014-04-14, accepted in 2014-10-27,  发布年份 2014

【 摘 要 】

Background

Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women.

Methods

A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women’s views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records.

Results

Study uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned.

Conclusions

Women were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.

【 授权许可】

   
2014 Forster et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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