Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia - A comparative cohort study.

Kildea, S; Gao, Y; Rolfe, M; Josif, CM; Bar-Zeev, SJ; Steenkamp, M; Kruske, S; Williams, D; Dunbar, T; Barclay, LM

Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia - A comparative cohort study.

Kildea, S Gao, Y Rolfe, M Josif, CM Bar-Zeev, SJ Steenkamp, M Kruske, S

Williams, D Dunbar, T Barclay, LM

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Publisher:: ELSEVIER SCI LTD
Publication Type:: Journal Article
Citation:: Midwifery, 2016, 34, pp. 47-57
Issue Date:: 2016-03

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Field	Value	Language
dc.contributor.author	Kildea, S
dc.contributor.author	Gao, Y
dc.contributor.author	Rolfe, M
dc.contributor.author	Josif, CM
dc.contributor.author	Bar-Zeev, SJ
dc.contributor.author	Steenkamp, M
dc.contributor.author	Kruske, S https://orcid.org/0000-0002-2317-3954
dc.contributor.author	Williams, D
dc.contributor.author	Dunbar, T
dc.contributor.author	Barclay, LM
dc.date.accessioned	2022-08-05T01:16:37Z
dc.date.available	2016-01-20
dc.date.available	2022-08-05T01:16:37Z
dc.date.issued	2016-03
dc.identifier.citation	Midwifery, 2016, 34, pp. 47-57
dc.identifier.issn	0266-6138
dc.identifier.issn	1532-3099
dc.identifier.uri	http://hdl.handle.net/10453/159629
dc.description.abstract	OBJECTIVE: to compare the quality of care before and after the introduction of the new Midwifery Group Practice. DESIGN: a cohort study. SETTING: the health centers (HCs) in two of the largest remote Aboriginal communities (population 2200-2600) in the Top End of the Northern Territory (NT), each located approximately 500km from Darwin. The third study site was the Royal Darwin Hospital (RDH) which provides tertiary care. METHODS: a 2004-06 retrospective cohort (n=412 maternity cases) provided baseline data. A clinical redesign of maternity services occurring from 2009 onwards focused on increasing Continuity of Carer, Communication, Choice, Collaboration and Co-ordination of Care (5Cs). Data from a 2009-11 prospective cohort (n=310 maternity cases) were collected to evaluate the service redesign. Outcome measures included indicators on the quality of care delivery, adherence to recommended antenatal guidelines and maternal and neonatal health outcomes. FINDINGS: statistically significant improvements were recorded in many areas reflecting improved access to, and quality of, care. For example: fewer women had <4 visits in pregnancy (14% versus 8%), a higher proportion of women had routine antenatal tests recorded (86% versus 97%) and improved screening rates for urine (82% versus 87%) and sexual tract infections (78% versus 93%). However, the treatment of conditions according to recommended guidelines worsened significantly in some areas; for example antibiotics prescribed for urine infections (86% versus 52%) and treatment for anaemia in pregnancy (77% versus 67%). High preterm (21% versus 20%), low birth weight (18% versus 20%) and PPH (29% versus 31%) rates did not change over time. The out of hospital birth rate remained high and unchanged in both cohorts (10% versus 10%). CONCLUSION: this model addresses some of the disparities in care for remote-dwelling Aboriginal women. However, much work still needs to occur before maternity care and outcomes are equal to that of non-Aboriginal women. Targeted program interventions with stronger clinical governance frameworks to improve the quality of care are essential. A complete rethink of service delivery and engagement may deliver better results.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	ELSEVIER SCI LTD
dc.relation	http://purl.org/au-research/grants/nhmrc/422503
dc.relation.ispartof	Midwifery
dc.relation.isbasedon	10.1016/j.midw.2016.01.009
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1110 Nursing, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services
dc.subject.classification	Nursing
dc.subject.mesh	Adult
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Medically Underserved Area
dc.subject.mesh	Midwifery
dc.subject.mesh	Models, Nursing
dc.subject.mesh	Native Hawaiian or Other Pacific Islander
dc.subject.mesh	Northern Territory
dc.subject.mesh	Outcome Assessment, Health Care
dc.subject.mesh	Pregnancy
dc.subject.mesh	Pregnancy Outcome
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Young Adult
dc.subject.mesh	Humans
dc.subject.mesh	Pregnancy Outcome
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Midwifery
dc.subject.mesh	Pregnancy
dc.subject.mesh	Models, Nursing
dc.subject.mesh	Adult
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Medically Underserved Area
dc.subject.mesh	Northern Territory
dc.subject.mesh	Female
dc.subject.mesh	Young Adult
dc.subject.mesh	Outcome Assessment, Health Care
dc.subject.mesh	Native Hawaiian or Other Pacific Islander
dc.title	Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia - A comparative cohort study.
dc.type	Journal Article
utslib.citation.volume	34
utslib.location.activity	Scotland
utslib.for	1110 Nursing
utslib.for	1114 Paediatrics and Reproductive Medicine
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2022-08-05T01:16:36Z
pubs.publication-status	Published
pubs.volume	34

Abstract:

OBJECTIVE: to compare the quality of care before and after the introduction of the new Midwifery Group Practice. DESIGN: a cohort study. SETTING: the health centers (HCs) in two of the largest remote Aboriginal communities (population 2200-2600) in the Top End of the Northern Territory (NT), each located approximately 500km from Darwin. The third study site was the Royal Darwin Hospital (RDH) which provides tertiary care. METHODS: a 2004-06 retrospective cohort (n=412 maternity cases) provided baseline data. A clinical redesign of maternity services occurring from 2009 onwards focused on increasing Continuity of Carer, Communication, Choice, Collaboration and Co-ordination of Care (5Cs). Data from a 2009-11 prospective cohort (n=310 maternity cases) were collected to evaluate the service redesign. Outcome measures included indicators on the quality of care delivery, adherence to recommended antenatal guidelines and maternal and neonatal health outcomes. FINDINGS: statistically significant improvements were recorded in many areas reflecting improved access to, and quality of, care. For example: fewer women had <4 visits in pregnancy (14% versus 8%), a higher proportion of women had routine antenatal tests recorded (86% versus 97%) and improved screening rates for urine (82% versus 87%) and sexual tract infections (78% versus 93%). However, the treatment of conditions according to recommended guidelines worsened significantly in some areas; for example antibiotics prescribed for urine infections (86% versus 52%) and treatment for anaemia in pregnancy (77% versus 67%). High preterm (21% versus 20%), low birth weight (18% versus 20%) and PPH (29% versus 31%) rates did not change over time. The out of hospital birth rate remained high and unchanged in both cohorts (10% versus 10%). CONCLUSION: this model addresses some of the disparities in care for remote-dwelling Aboriginal women. However, much work still needs to occur before maternity care and outcomes are equal to that of non-Aboriginal women. Targeted program interventions with stronger clinical governance frameworks to improve the quality of care are essential. A complete rethink of service delivery and engagement may deliver better results.

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http://hdl.handle.net/10453/159629