Client-centered flexible planning of home-based postpartum care: A randomized controlled trial on the quality of care

IF 2.8 3区医学 Q1 NURSING Birth-Issues in Perinatal Care Pub Date : 2024-05-08 DOI:10.1111/birt.12824

Fleur J. Lambermon PhD, Noortje T. L. van Duijnhoven PhD, Christine Dedding PhD, Jan A. M. Kremer PhD

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Abstract

Background

Standardization of health systems often hinders client-centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home-based postpartum care service improves its quality of care, as innovative approach to client-centered care.

Methods

A randomized controlled trial was conducted (2017–2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th-day postpartum, instead of the first 8–10 consecutive days (“usual care”). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so-called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self-care experience, overall care experience, and exclusive breastfeeding duration rate.

Results

Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98–1.07). Both groups showed similar self-care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates.

Conclusions

This study found no effect on the quality of care when allowing more flexibility in the planning range of home-based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home-based postpartum care.

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以客户为中心灵活规划家庭产后护理：关于护理质量的随机对照试验。

背景：医疗系统的标准化往往会阻碍以客户为中心的护理。作为以客户为中心的护理的创新方法，本研究调查了允许荷兰家庭式产后护理服务的计划范围更具灵活性是否会提高其护理质量：进行了一项随机对照试验（2017-2019 年），将打算母乳喂养的孕妇分为两组（1:1）。干预组允许在产后第14天前接受护理，而不是最初的连续8-10天（"常规护理"）。主要结果指标是在服务的最后护理日仍在接受纯母乳喂养的新生儿比例。荷兰卫生部门目前使用这一所谓的成功母乳喂养率来衡量护理质量。次要结果指标包括自我护理体验、总体护理体验和纯母乳喂养持续率：根据 1275 名参与者的数据，最后护理日的纯母乳喂养率没有差异（干预组为 86.7%，对照组为 88.9%，RR：1.03，95% CI：0.98-1.07）。两组的自我护理经验相似。干预组妇女的整体护理经验稍差，纯母乳喂养持续率较低：本研究发现，如果能更灵活地规划家庭产后护理的范围，则不会对护理质量产生影响。因此，可以为妇女提供更多适合她们的灵活性。鉴于对该行业当前主要质量指标的解释存在混乱，我们呼吁就如何更好地衡量家庭式产后护理的质量开展包容性对话。

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来源期刊

Birth-Issues in Perinatal Care 医学-妇产科学

CiteScore

4.10

自引率

4.00%

发文量

审稿时长

>12 weeks

期刊介绍： Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.