Autoři: Jane Yelland aff001; Fiona Mensah aff003; Elisha Riggs aff001; Ellie McDonald aff001; Josef Szwarc aff005; Wendy Dawson aff001; Dannielle Vanpraag aff001; Sue Casey aff005; Christine East aff006; Mary Anne Biro aff006; Glyn Teale aff008; Sue Willey aff006; Stephanie J. Brown aff001 Působiště autorů: Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia aff001; Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia aff002; Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia aff003; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia aff004; Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia aff005; School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia aff006; School of Nursing and Midwifery, Mercy Health and La Trobe University, Bundoora, Victoria, Australia aff007; Women’s and Children’s, Western Health, Sunshine, Victoria, Australia aff008 Vyšlo v časopise: Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003089 Kategorie: Research Article doi: https://doi.org/10.1371/journal.pmed.1003089
Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this ‘whole-of-system’ approach was to improve access to antenatal care. The objective of this paper is to report refugee women’s access to hospital-based antenatal care over the period of health system reforms.
The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks’ gestation compared over time and to Australian-born women using logistic regression analyses.
In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks’ gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting.
Accurate ascertainment of ‘harder-to-reach’ populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.
Antenatal care – Birth – diabetes mellitus – Child health – Language – Network analysis – Pregnancy – Gestational diabetes
1. World Health Organization [Internet]. WHO recommendations on antenatal care for a positive pregnancy experience. Switzerland: WHO; 2016 [cited 2019 Aug 16]. Avaialable from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/.
2. Dowswell T, Carroli G, Duley L, Gates S, Gulmezoglu AM, Khan-Neelofur D, et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane DatabaseSyst Rev. 2015(7):Cd000934.
3. Department of Health [Internet]. Clinical Practice Guidelines: Pregnancy Care. Canberra: Australian Government Department of Health; 2018 [cited 2019 Jul 19]. Available from: https://www.health.gov.au/resources/publications/pregnancy-care-guidelines.
4. Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, et al. Routine Prenatal Care. ICSI Health Care Guidelines [Internet]. 2012 [cited 2020 Jun 23]; 15. Available from: https://www.bmchp.org/~/media/23e81f82425240699b6a73c9582fc84c.pdf.
5. Australian Institute of Health and Welfare [Internet]. Australia's health 2016. Canberra: Australian Institute of Health and Welfare; 2016 [cited 2019 Jul 19]. Available from: https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/summary.
6. Paxton G, Smith N, Win A, Mulholland N, Hood S, Victorian Department Education and Early Childhood Development. Refugee Status Report. A report on how refugee children and young people in Victoria are faring [Internet]. Melbourne: DEECD; 2011 [cited 2019 Jul 18]. Available from: https://www.education.vic.gov.au/Documents/about/research/refugeestatusreport.pdf.
7. Gibson‐Helm ME, Teede HJ, Cheng IH, Block AA, Knight M, East CE, et al. Maternal Health and Pregnancy Outcomes Comparing Migrant Women Born in Humanitarian and Nonhumanitarian Source Countries: A Retrospective, Observational Study. Birth. 2015;42(2): 116–24. doi: 10.1111/birt.12159 25864573
8. Davies-Tuck ML, Davey MA, Wallace EM. Maternal region of birth and stillbirth in Victoria, Australia 2000–2011: A retrospective cohort study of Victorian perinatal data. PLoS ONE. 2017;12(6): e0178727. doi: 10.1371/journal.pone.0178727 28586367
9. Phillimore J. Migrant maternity in an era of superdiversity: New migrants' access to, and experience of, antenatal care in the West Midlands, UK. Soc Sci Med. 2016; 148 : 152–9. doi: 10.1016/j.socscimed.2015.11.030 26705910
10. Small R, Gagnon A, Gissler M, Zeitlin J, Bennis M, Glazier R, et al. Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG. 2008;115(13):1630–40. doi: 10.1111/j.1471-0528.2008.01942.x 19035939
11. Centre for Maternal and Child Enquiries. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG. 2011;118(Supp. 1): 1–203.
12. Yelland J, Riggs E, Wahidi S, Fouladi F, Casey S, Szwarc J, et al. How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy Childbirth. 2014;14(1): 348.
13. Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, et al. Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implement Sci. 2015;10(1): 62.
14. Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med. 2015;12(10): e1001885. doi: 10.1371/journal.pmed.1001885 26440803
15. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4): 581–629. doi: 10.1111/j.0887-378X.2004.00325.x 15595944
16. Yelland J, Riggs E, Szwarc J, Vanpraag D, Dawson W, Brown S. Improving the ascertainment of refugee-background people in health datasets and health services. Aust Health Rev. 2018;42(2): 130–133. doi: 10.1071/AH16164 28147213
17. Vanpraag D, Dawson W, Bell B, Riggs E, Szwarc J, Brown S, et al. Enhancing general practice referrals for women of refugee background to maternity care. Aust J Prim Health. 2018;24(2): 123–129. doi: 10.1071/PY17105 29609730
18. Riggs E, Muyeen S, Brown S, Dawson W, Petschel P, Tardiff W, et al. Cultural safety and belonging for refugee background women attending group pregnancy care: An Australian qualitative study. Birth. 2017;44(4): 145–52.
19. Yelland J, Biro MA, Dawson W, Riggs E, Vanpraag D, Wigg K, et al. Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women duing labour. Aust Health Rev. 2016;41(5): 499–504.
20. Paxton GA, Kay MP, Correa-Velez I. Lost and found: improving ascertainment of refugee-background Australians in population datasets. Med J Aust. 2012;197(10): 552–3.
21. Australian Government Department of Home Affairs [Internet]. Settlement Reports. Canberra: Australian Government Department of Social Services; 2018 [cited 2019 Jun 24]. Available from: https://data.gov.au/data/dataset/settlement-reports.[accessed 2019 June 24]
22. StataCorp. Stata Statistical Software: Release 15. College Station, Texas: StatCorp LP; 2017 [cited 2019 Aug 22]. Available from: https://www.stata.com/.
23. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12 : 18. doi: 10.1186/1475-9276-12-18 23496984
24. Braithwaite J, Churruca K, Long JC, Ellis LA, Herkes J. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med. 2018;16(1): 63. doi: 10.1186/s12916-018-1057-z 29706132
25. Long KM, McDermott F, Meadows GN. Being pragmatic about healthcare complexity: our experiences applying complexity theory and pragmatism to health services research. BMC Med. 2018;16(1): 94. doi: 10.1186/s12916-018-1087-6 29921277
26. Duckett S. Targeting zero: Supporting the Victorian hospital system to eliminate avaoidable harm and strenthen quality of care. Melbourne: Victorian Government; 2016 [cited 2019 Aug 22]. Available from: https://www.dhhs.vic.gov.au/publications/targeting-zero-review-hospital-safety-and-quality-assurance-victoria.
27. Lopez Bernal J, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. Int J Epidemiol. 2018;47(6): 2082–93. doi: 10.1093/ije/dyy135 29982445
28. Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13(6 Suppl): S38–44. doi: 10.1016/j.acap.2013.08.002 24268083
29. Venkataramani AS, Underhill K, Volpp KG. Moving Toward Evidence-Based Policy: The Value of Randomization for Program and Policy Implementation. JAMA. 2020;323(1): 21–2.
30. Robertshaw L, Dhesi S, Jones LL. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open. 2017;7(8): e015981. doi: 10.1136/bmjopen-2017-015981 28780549
Zvyšte si kvalifikaci online z pohodlí domova
Nemáte účet? Registrujte se
Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.
