Talukdar Sutapa, Dingle Kaeleen, Miller Yvette D
School of Public Health and Social Work, Queensland University of Technology, Queensland, Kelvin Grove, QLD 4059, Australia.
School of Public Health and Social Work, Queensland University of Technology, Queensland, Kelvin Grove, QLD 4059, Australia..
Midwifery. 2021 Aug;99:102973. doi: 10.1016/j.midw.2021.102973. Epub 2021 Feb 28.
To synthesize available evidence comparing outcomes and experiences of care received in different maternity models in Australia and identify the information gaps hindering women's decisions between alternative models.
A literature search was conducted to identify published research over the last twenty years that directly compared clinical and/or experiential outcomes of women in different maternity models of care in Australia. Outcome measures of included articles were identified and assessed to evaluate current comparative information available to women and health professionals. The quality of included studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tools for randomised controlled studies (RCTs) and cohort studies. Quantitative data were extracted and synthesised for further analysis.
SETTING/PARTICIPANTS: Published studies comparing at least two maternity care models providing antenatal, intrapartum and postpartum care in Australia.
Eight studies (five RCTs and three observational studies) met inclusion criteria. Seven studies compared the outcomes of public midwifery continuity care and standard public care and one compared the outcomes of public midwifery continuity care, standard care and private obstetric care. There was no evidence directly comparing all broadly categorised available models in Australia. Data for clinical outcomes were collected from hospital records and experiential data were self-reported. Seven out of eight studies used data collected from single public hospital settings and one study included data from two tertiary hospitals. Women in public midwifery continuity models were more likely to have unassisted vaginal births, continuity of care and satisfaction and lower use of interventions (i.e., episiotomy, induction of labour, use of analgesia) and neonatal admission in intensive care units (ICU), compared with those in standard public models (and private obstetric care in one study).
This scoping review reveals lack of reliable direct comparison of clinical and experiential outcomes across the multiple available public and private maternity models of care in Australia. Quality alignment between women's needs and their maternity model of care can prevent under or over specialised care and avoidable health system costs. Comprehensive information comparing all available maternity care models can guide gatekeeper health professionals and women to choose the best model according to women's needs and preferences. There is a need for research providing more comprehensive and ecological comparisons between available models of maternity care to inform such decision making support. Moreover, women's experiential data across maternity model of care comparisons could be used more consistently to better represent the relative outcomes of alternative models from a consumer-centred perspective.
综合现有证据，比较澳大利亚不同孕产模式下的护理结果和体验，并找出阻碍女性在不同模式之间做出选择的信息缺口。
进行文献检索，以确定过去二十年中直接比较澳大利亚不同孕产护理模式下女性临床和/或体验结果的已发表研究。确定并评估纳入文章的结果指标，以评估女性和医疗专业人员目前可获得的比较信息。使用乔安娜·布里格斯研究所（JBI）针对随机对照试验（RCT）和队列研究的批判性评价工具评估纳入研究的质量。提取并综合定量数据以进行进一步分析。
设置/参与者：已发表的研究，比较了澳大利亚至少两种提供产前、产时和产后护理的孕产护理模式。
八项研究（五项RCT和三项观察性研究）符合纳入标准。七项研究比较了公共助产士连续性护理和标准公共护理的结果，一项研究比较了公共助产士连续性护理、标准护理和私立产科护理的结果。没有证据直接比较澳大利亚所有大致分类的可用模式。临床结果数据从医院记录中收集，体验数据通过自我报告获得。八项研究中有七项使用了从单一公立医院收集的数据，一项研究包括了两家三级医院的数据。与标准公共模式（以及一项研究中的私立产科护理）相比，采用公共助产士连续性模式的女性更有可能顺产、获得连续护理并感到满意，干预措施（即会阴切开术、引产、使用镇痛剂）的使用和新生儿入住重症监护病房（ICU）的情况更少。
这项范围综述揭示，澳大利亚多种可用的公共和私立孕产护理模式在临床和体验结果方面缺乏可靠的直接比较。女性需求与其孕产护理模式之间的质量匹配可以防止护理不足或过度专业化，并避免可避免的卫生系统成本。比较所有可用孕产护理模式的全面信息可以指导把关医疗专业人员和女性根据女性的需求和偏好选择最佳模式。需要开展研究，对可用的孕产护理模式进行更全面和生态的比较，以为此类决策支持提供信息。此外，在比较不同孕产护理模式时，可以更一致地使用女性的体验数据，以便从以消费者为中心的角度更好地呈现不同模式的相对结果。
