Evaluation of a reduced-frequency prenatal visit schedule for low-risk women at a free-standing birthing center

Walker, Deborah S.; Koniak‐Griffin, Deborah

doi:10.1016/s0091-2182(97)00027-x

Cited by 33 publications

(28 citation statements)

References 26 publications

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“…Seven trials evaluated the number of visits; four of which were conducted in high-income countries (individual randomisation trials) (England 1996; USA 1995; USA 1996; USA 1997) and three in low- and middle-income countries (cluster-randomisation trials, with clinics as the unit of randomisation) (WHO 2001; Zimbabwe 1996; Zimbabwe 2007). All trials recruited both primiparous and multiparous women.…”

Section: Resultsmentioning

confidence: 99%

“…In the studies where there was individual randomisation, women identified as having risk factors were excluded. In these trials gestation at recruitment was: before 13 weeks (USA 1996), before 18 weeks (USA 1995), before 22 weeks (England 1996), and before 26 weeks (USA 1997). Of the cluster-randomisation trials, two recruited all women attending antenatal clinics (WHO 2001; Zimbabwe 2007) whilst the third recruited all low-risk women (Zimbabwe 1996).…”

Section: Resultsmentioning

confidence: 99%

“…Reduced care was goal-orientated for the three cluster-randomised trials, with one trial using four visits (WHO 2001), one five visits (Zimbabwe 2007) and the third six visits (Zimbabwe 1996); assessment of risk factors at booking was an important part of these interventions. For the individual randomised trials, one used seven visits for nulliparous women and six for multiparous (England 1996); two used eight visits for all women (USA 1995; USA 1997); and one nine visits for all women (USA 1996). In one study, women in the reduced visits group had a single care provider, whilst women in the standard care group had a mix of care providers (USA 1995).…”

Section: Resultsmentioning

confidence: 99%

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Alternative versus standard packages of antenatal care for low-risk pregnancy

Dowswell

Carroli

Duley

et al. 2010

Cochrane Database of Systematic Reviews

203

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Background The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation. Objectives To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (April 2010), reference lists of articles and contacted researchers in the field. Selection criteria Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care. Data collection and analysis Two authors assessed trial quality and extracted data independently. Main results We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more ‘goal oriented’. Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1.32). Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02). There were no clear differences between the groups for the other reported clinical outcomes. Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs. Authors’ conclusions In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Alternative versus standard packages of antenatal care for low-risk pregnancy

Dowswell

Carroli

Duley

et al. 2010

Cochrane Database of Systematic Reviews

203

View full text Add to dashboard Cite

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“…Women’s satisfaction levels were lower in three studies ([48–50]). Only one study showed a slight increase in satisfaction ([51]), although the sample size was very small ( n = 43 intervention, n = 38 control). In Sikorski et al’s study [48], dissatisfaction was assumed if the women would have preferred more visits in the intervention arm, or fewer visits in the control arm.…”

Section: Resultsmentioning

confidence: 99%

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Symon

Pringle

Downe

et al. 2017

BMC Pregnancy Childbirth

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BackgroundAntenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models.MethodsA protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions.ResultsOf 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted ‘lower-risk’-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted ‘higher-risk’-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers.ConclusionsInterventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproduc...

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“…Most have found that a reduced schedule of visits among low-risk women could be implemented without increasing adverse maternal or fetal outcomes such as preterm delivery, preeclampsia, and low birth weight [ 6 – 12 ], although there is mixed evidence on perinatal mortality [ 11 , 13 ]. Some studies found patient satisfaction was unchanged [ 6 ] or improved [ 9 , 10 ], but a larger number suggest that patient satisfaction decreases with lower numbers of visits [ 7 , 8 , 11 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a new prenatal care model to reduce office visits and increase connectivity and continuity of care: protocol for a mixed-methods study

Ridgeway

LeBlanc

Branda

et al. 2015

BMC Pregnancy Childbirth

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BackgroundMost low-risk pregnant women receive the standard model of prenatal care with frequent office visits. Research suggests that a reduced schedule of visits among low-risk women could be implemented without increasing adverse maternal or fetal outcomes, but patient satisfaction with these models varies. We aim to determine the effectiveness and feasibility of a new prenatal care model (OB Nest) that enhances a reduced visit model by adding virtual connections that improve continuity of care and patient-directed access to care.Methods and designThis mixed-methods study uses a hybrid effectiveness-implementation design in a single center randomized controlled trial (RCT). Embedding process evaluation in an experimental design like an RCT allows researchers to answer both “Did it work?” and “How or why did it work (or not work)?” when studying complex interventions, as well as providing knowledge for translation into practice after the study. The RE-AIM framework was used to ensure attention to evaluating program components in terms of sustainable adoption and implementation.Low-risk patients recruited from the Obstetrics Division at Mayo Clinic (Rochester, MN) will be randomized to OB Nest or usual care. OB Nest patients will be assigned to a dedicated nursing team, scheduled for 8 pre-planned office visits with a physician or midwife and 6 telephone or online nurse visits (compared to 12 pre-planned physician or midwife office visits in the usual care group), and provided fetal heart rate and blood pressure home monitoring equipment and information on joining an online care community.Quantitative methods will include patient surveys and medical record abstraction. The primary quantitative outcome is patient-reported satisfaction. Other outcomes include fidelity to items on the American Congress of Obstetricians and Gynecologists standards of care list, health care utilization (e.g. numbers of antenatal office visits), and maternal and fetal outcomes (e.g. gestational age at delivery), as well as validated patient-reported measures of pregnancy-related stress and perceived quality of care. Quantitative analysis will be performed according to the intention to treat principle. Qualitative methods will include interviews and focus groups with providers, staff, and patients, and will explore satisfaction, intervention adoption, and implementation feasibility. We will use methods of qualitative thematic analysis at three stages. Mixed methods analysis will involve the use of qualitative data to lend insight to quantitative findings.DiscussionThis study will make important contributions to the literature on reduced visit models by evaluating a novel prenatal care model with components to increase patient connectedness (even with fewer pre-scheduled office visits), as demonstrated on a range of patient-important outcomes. The use of a hybrid effectiveness-implementation approach, as well as attention to patient and provider perspectives on program components and implementation, may uncover important information tha...

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Evaluation of a reduced-frequency prenatal visit schedule for low-risk women at a free-standing birthing center

Cited by 33 publications

References 26 publications

Alternative versus standard packages of antenatal care for low-risk pregnancy

Alternative versus standard packages of antenatal care for low-risk pregnancy

Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models

Implementation of a new prenatal care model to reduce office visits and increase connectivity and continuity of care: protocol for a mixed-methods study

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