What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units

BMC Pregnancy and Childbirth

Nathalie Leister¹  Lucia Rocca-Ihenacho¹  Laura Batinelli¹  Christine McCourt¹  Ellen Thaels²  Manila Bonciani³ 

[1] Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, EC1R 1UW, London, UK;Faculty of Health & Wellbeing, School of Community Health and Midwifery, University of Central Lancashire, UCLAN, Brook Building, Victoria Street, PR17QT, Preston, UK;Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, CAP 56127, Pisa, Italy;

关键词: Midwifery units;    Midwifery led care;    Birth centres;    Midwifery centres;    Primary care models;    Implementation;    Innovation;    Adoption;    Metasynthesis;    Qualitative research;   

DOI  :  10.1186/s12884-022-04410-x

来源: Springer

【 摘 要 】

BackgroundMidwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach.MethodsA systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies.ResultsFrom 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings.ConclusionsThe studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.

【 授权许可】

CC BY