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Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India

HEALTH POLICY AND PLANNING 1999年第1期14卷 38-48页

作者： Bloom, SS Lippeveld, T Wypij, D Univ N Carolina Carolina Populat Ctr Chapel Hill NC 27516 USA John Snow Inc Rabat Morocco Harvard Univ Sch Publ Hlth Boston MA 02115 USA

Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers. This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator - two or more visits versus less - masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75(th) percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25(th) percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.

关键词：接生产科发展中国家卫生服务研究印度/流行病学产妇死亡率产前保健/组织和管理产前保健/标准社会经济因素市区卫生服务/组织和管理市区卫生服务/标准青少年成年人女(雌)性人类妊娠

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Maternal substance abuse and infant health: Policy options across the life course

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MILBANK QUARTERLY 1999年第4期77卷 531-+页

作者： Frohna, JG Lantz, PM Pollack, H Univ Michigan Sch Med Dept Internal Med Taubman Ctr 3110G Ann Arbor MI 48109 USA Univ Michigan Sch Med Dept Pediat Ann Arbor MI 48109 USA

Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.

关键词：青少年保健服务/组织和管理年龄因素儿童保健服务/组织和管理综合保健/组织和管理病人医护连续性/组织和管理卫生政策婴儿福利产妇卫生保健服务/组织和管理妊娠并发症/流行病学妊娠并发症/预防和控制产前保健/组织和管理物质相关性障碍/流行病学物质相关性障碍/预防和控制美国/流行病学妇女卫生青少年女(雌)性人类婴儿新生妊娠

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Model of family medicine and obstetrics-gynecology collaboration in obstetric care at the University of Michigan

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OBSTETRICS AND GYNECOLOGY 2000年第2期96卷 308-313页

作者： Berman, DR Johnson, TRB Apgar, BS Schwenk, TL Univ Michigan Hlth Syst Dept Obstet & Gynecol Ann Arbor MI 48109 USA Univ Michigan Hlth Syst Dept Family Med Ann Arbor MI 48109 USA

Objective: To assess concordance between family physician obstetric privilege delineation and actual care delivered, and describe associated clinical and educational collaborations between family medicine and obstetrics and gynecology. Methods: We conducted a descriptive retrospective review of the care and complications of 962 consecutive patients admitted to a family medicine obstetric service in a research-intensive academic medical center, and compared the results with a structured obstetric privilege delineation. Results: Of 962 women admitted by family medicine faculty members, 741 (77.9%) were managed exclusively by family physicians, 63 (6.6%) were comanaged by family physicians and obstetricians, and 147 (15.5%) were transferred to obstetricians (data missing for 11 patients). Spontaneous vaginal deliveries were performed in 772 patients (81%), cesarean delivery in 116 patients (12.2%), and assisted delivery by forceps or vacuum in 19 (2%) and 44 (4.6%) patients, respectively. Of 926 intrapartum obstetric complications identified in 604 obstetric deliveries, 615 complications (66.4%) in 418 deliveries were managed exclusively by family physicians consistent with privilege delineation, comanagement occurred in 56 patients with 92 complications (9.9%), and care was transferred in 130 patients with 219 complications (23.7%). Conclusion: A structured method of obstetric privilege delineation for family medicine faculty members and associated guidelines for family physician-obstetrician interactions has Led to a successful family medicine obstetric service at a research-intensive, tertiary-care medical center, with a high concordance between privilege delineation and actual care delivered. This success has resulted in incremental clinical and educational collaborations that have improved the quality of women's health care and education. ((C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：家庭医学/组织和管理医院大学职业间关系病案医务人员权利密执安模型组织管理产科学/组织和管理结果评价(卫生保健) 诊疗准则(主题) 产前保健/组织和管理产前保健/标准转诊和会诊/标准回顾性研究女(雌)性人类妊娠

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Does reducing the frequency of routine antenatal visits have long term effects? Follow up of participants in a randomised controlled trial

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999年第4期106卷 367-370页

作者： Clement, S Candy, B Sikorski, J Wilson, J Smeeton, N Univ London Kings Coll Guys Kings & St Thomas Sch Med Dept Gen Practice & Primary Care London England Univ London Kings Coll Guys Kings & St Thomas Sch Med Dept Publ Hlth Sci London England

1117 low risk women, who had been randomly allocated to either the traditional schedule of 13 antenatal visits or a reduced schedule of six to seven visits, were followed up 2.7 years after their delivery. Follow up was by means of a postal questionnaire (assessing the mother-child relationship, maternal psychological wellbeing, health service use, health-related behaviour and health beliefs), and patient record data on the frequency of contacts in general practice. There was no evidence of differences between the two groups for any of the outcomes examined. Offering a reduced schedule of routine antenatal visits to low risk women does not appear to have any long term effects.

关键词：病人预约和时间安排健康态度随访研究健康行为卫生服务/统计学和数值数据母子关系母亲/心理学产前保健/组织和管理女(雌)性人类妊娠

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The costs of alternative types of routine antenatal care for low-risk women: Shared care vs care by general practitioners and community midwives

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Journal of Health Services Research & Policy 1996年第3期1卷 135-140页

作者： Ratcliffe, Julie Ryan, Mandy Tucker, Janet Health Economics Research Unit Aberdeen United Kingdom Department of Epidemiology and Public Health Ninewells Hospital Dundee United Kingdom

To compare the costs to the health service, women and their families of routine antenatal care provided by either traditional obstetrician-led shared care or general practitioner (GP)/community midwife care. A multicentre randomized controlled trial in 51 general practices linked to nine maternity hospitals in Scotland: 1667 low-risk pregnant women provided information on costs to the health service. 704 of these women provided information on non-health service costs. GP/midwife antenatal care was found to cost statistically significantly less than shared care. This was the case for investigations carried out at routine antenatal visits (GP/midwife = £87.25, shared care = £91.15, P = 0.05), staffing costs at routine antenatal visits (GP/midwife = £127.76, shared care = £131.09, P = 0.001), and non-health service costs incurred by women and their companions (GP/midwife = £118.53, shared care = £133.49, P = 0.001). While non-routine care in the GP/midwife arm of the trial costs less than in the shared care arm, the difference was not statistically significant (GP/midwife = £83.74, shared care = £94.43, P = 0.46). The total societal cost of antenatal care was £417.28 per woman in the GP/midwife arm of the trial and £450.19 in the shared care arm of the trial. This difference was statistically significant (P < 0.001). The application of sensitivity analysis did not change these results. GP/midwife antenatal care is a satisfactory option for low-risk pregnant women in Scotland provided that clinical outcomes and women's satisfaction are at least the same as those of women with shared care. © 1996, SAGE Publications. All rights reserved.

关键词：费用节省/经济学评价研究家庭医学/经济学大不列颠卫生保健费用/统计学和数值数据卫生服务研究/方法助产学/经济学产科学/经济学产前保健/经济学产前保健/组织和管理危险因素苏格兰女(雌)性人类妊娠

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Providing birthing services in rural health networks: Coping with change in New York state

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JOURNAL OF RURAL HEALTH 1996年第2期12卷 137-145页

作者： Rosenthal, TC Ferrara, E Hesler, E SUNY BUFFALO DEPT FAMILY MED NEW YORK RURAL HLTH RES CTR 462 GRIDER ST BUFFALO NY 14215 USA

Making prenatal and birthing services accessible in rural communities no longer able to support a local full-service hospital and the introduction of managed care cost control has led to consideration of alternative models. One such model, the freestanding birth center located in an isolated rural community, challenges the guidelines of several state and professional organizations directed at assuring adequate emergency response, including cesarean sections. An extensive review of freestanding birth centers and their effect on birth outcomes revealed little outcomes data about birth centers distant from full-service hospitals. Most states have modeled their birth center regulations on recommendations from the National Association of Childbearing Centers, but others, such as New York, have more rigidly defined transport parameters that exclude many rural locations. A concensus panel convened by the New York State Rural Health Council concluded that demonstrations projects featuring a rural birthing center further than 20 minutes from a full-service hospital an operated within a networked rural health system should be developed. Consumers would need to be fully informed about the implications of their choice of birth services and all qualified providers, including midwives, should be included in a team approach to care giving.

关键词：产院/组织和管理产院/利用社区网络/组织和管理卫生服务易得程度模型组织管理纽约产科学组织改革试点项目妊娠结局产前保健/组织和管理乡村卫生服务/组织和管理乡村卫生服务/利用旅行女(雌)性人类妊娠

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Increasing access to prenatal care: An evaluation of minority health coalitions' early pregnancy project

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Journal of Community Health Nursing 2000年第2期17.0卷 93-105页

作者： Jewell, Nancy A. Russell, Kathleen M. Terry and Associates Indianapolis IN United States School of Nursing Ball State University United States Zionsville IN 46077 9197 East 300 South United States

Early prenatal care utilization is a problem for racial and ethnic minority women in Indiana. Minority health coalitions in Indiana developed early pregnancy care coordination projects to address this need. To evaluate project outcomes, birth certificates of infants born to project mothers were matched with birth certificates of infants whose mothers did not receive care coordination. Results showed that project mothers were significantly more likely to start prenatal care earlier, had better prenatal care utilization as measured by the Kessner Index (Kessner, Singer, Kalk, and Schlesinger, 1973), and had better adequacy of care as measured by the APNCU Index (Kotelchuck, 1994) than the noncare-coordinated mothers. Although the project was successful in meeting its primary objective, specific recommendations are made for community health nurses to partner with the coalitions in improving the content of prenatal care, decreasing sociocultural barriers to care, and assisting in the evaluation of outcomes of future projects.

关键词：社区保健护理卫生保健联合体健康促进/方法卫生服务易得程度印第安纳干预性研究结果评价(卫生保健) 产前保健/组织和管理青少年成年人女(雌)性人类妊娠

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Selection bias in prenatal care utilization: An interdisciplinary framework and review of the literature

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MEDICAL CARE RESEARCH AND REVIEW 1996年第4期53卷 371-396页

作者： Frick, KD Lantz, PM UNIV MICHIGAN ANN ARBORMI 48109

Since there are no randomized trials of standard prenatal care, it is difficult to assess its impact an birth outcomes without controlling for selection processes that can inhibit or promote its use. In this article, we develop a typology of selection processes in prenatal care utilization, identifying four distinct types of selection and their possible biasing effects on estimates of prenatal care efficacy. Second, using an interdisciplinary framework, we review the published studies on birth outcomes that consider selectivity in prenatal care, all of which have been published in the economics literature. The results from these studies suggest that selectivity in the use of care does exist and that the predominant process is one of adverse selection. This implies that analyses failing to control for selection will underestimate the effects of prenatal care. Third, we discuss the public health policy implications of these findings and offer an agenda for future research.

关键词：出生体重卫生政策卫生服务研究/方法婴儿死亡率病人接受卫生保健的程度妊娠结局产前保健/组织和管理产前保健/利用选择偏倚美国/流行病学女(雌)性人类婴儿妊娠

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An economic evaluation comparing two schedules of antenatal visits

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Journal of Health Services Research and Policy 2000年第2期5卷 69-75页

作者： Henderson, J. Roberts, T. Sikorski, J. Wilson, J. Clement, S. Natl. Perinatal Epidemiol. Unit Institute of Health Sciences Oxford United Kingdom

Objectives: To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. Methods: Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This took place between 1993 and 1994 in antenatal clinics in South East London and involved 2794 women at low risk of complications. Results: The estimated baseline costs to the UK National Health Service (NHS) for the traditional schedule were £544 per woman, of which £251 occurred antenatally, with a range of £327-1203 per woman. The estimated baseline costs to the NHS for the reduced visit schedule was £563 per woman, of which £225 occurred antenatally, with a range of £274-1741 per woman. Savings from new style care that arose antenatally were offset by the greater numbers of babies in this group who required special or intensive care. Sensitivity analyses based on possible variations in unit costs and resource use and modelled postnatal stay showed considerable variation and substantial overlap in costs. Conclusions: Patterns of antenatal care involving fewer routine visits for women at low risk of complications are unlikely to result in savings to the Health Service. In addition, women who had the reduced schedule of care reported greater dissatisfaction with their care and poorer psychosocial outcomes which argues against reducing numbers of antenatal visits. (C) The Royal Society of Medicine Press Ltd 2000.

关键词：费用效益分析大不列颠诊室就医/经济学诊室就医/统计学和数值数据产前保健/经济学产前保健/组织和管理敏感性与特异性公费医疗/经济学女(雌)性人类

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