Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial.
Background: Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.Meth...
| Publicado en: | Lancet Vol. 359; no. 9304; pp. 378 - 386 |
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| Autores principales: | , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Lancet
2/2/2002
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106537630&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106537630 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 2/2/2002 vid: 359 iid: 9304 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 106537630 106537630 NLM11844507 2009049009 10.1016/s0140-6736(02)07596-7 NLM11844507 106537630 ppf: 378 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial. aug: au: MacArthur C Winter HR Bick DE Knowles H Lilford R Henderson C Lancashire RJ Braunholtz DA Gee H MacArthur, C Winter, H R Bick, D E Knowles, H Lilford, R Henderson, C Lancashire, R J Braunholtz, D A Gee, H affil: Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK sug: subj: Health Status Home Visits Mental Health Certified Nurse Midwives Postnatal Care Adult Cluster Analysis Confidence Intervals Depression Diagnosis Edinburgh Postnatal Depression Scale England Family Practice Female Intervention Trials Intraclass Correlation Coefficient Odds Ratio Postnatal Period Psychological Tests Psychological Well-Being Quality of Life Questionnaires Random Assignment Short Form-36 Health Survey (SF-36) Funding Source Human Adult: 19-44 years Female ab: Background: Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.Methods: We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects.Findings: 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ.Interpretation: Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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