Abstract
Objectives: To determine whether the outcomes of routine home visiting by public health nurses (PHN) after early obstetrical discharge differ from those of a screening telephone call designed to identify mothers who need further intervention.
Methods: Primiparas delivering a singleton infant and eligible for postpartum follow-up were randomized to a home visit or screening telephone call. Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario. Outcomes included maternal confidence at two weeks, health problems of the infants between discharge and four weeks postpartum, breastfeeding rates at six months and costs of the two models.
Results: Differences between the samples at the two sites necessitated stratified analyses. No differences were detected between the groups in maternal confidence (p=0.96), health problems of infants (p=0.87), or rates of breastfeeding at six months (p=0.22). However, at both sites the cost of routine home visits was found to be higher than that of screening by telephone.
Conclusion: Although universal access to postpartum support is important, the results suggest that a routine home visit is not always necessary to identify the women who need it. These results can be generalized only to low-risk women and infants.
Résumé
Objectifs: Déterminer si les résultats de visites à domicile ordinaires effectuées par des infirmières de santé publique auprès de mères ayant reçu un congé précoce après l’accouchement diffèrent de ceux d’un programme d’appels téléphoniques visant à identifier les mères ayant besoin de soutien.
Méthode: Des primipares admissibles au suivi post-partum et ayant accouché d’un nourrisson unique ont reçu de façon aléatoire une visite à domicile ou un appel téléphonique de dépistage. Les données ont été recueillies par téléphone auprès de 733 participantes dans deux établissements de soins tertiaires en Ontario. Les résultats étudiés comprenaient l’assurance manifestée par la mère après deux semaines, les problèmes de santé du nourrisson entre la date du congé et quatre semaines après l’accouchement, le taux d’allaitement à six mois et les coûts des deux modèles.
Résultats: Les différences entre les échantillons aux deux établissements ont nécessité des analyses stratifiées. Aucune différence n’a été observée d’un groupe à l’autre à l’égard de l’assurance maternelle (p=0,96), des problèmes de santé du nourrisson (p=0,87) ou du taux d’allaitement à six mois (p=0,22). Toutefois, dans les deux établissements, le coût des visites à domicile ordinaires était plus élevé que celui du dépistage téléphonique.
Conclusion: Bien que l’accès universel au soutien post-partum soit important, ces résultats laissent entendre qu’une visite à domicile ordinaire n’est pas toujours nécessaire pour déterminer les mères qui ont besoin de soutien. Ces résultats ne peuvent être généralisés qu’aux mères et aux nourrissons à risque modéré.
Footnotes
Acknowledgements: The financial assistance of The Physicians’ Services Incorporated Foundation is gratefully acknowledged.
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