Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: a continuous quality improvement initiative.
BMC Pregnancy Childbirth
; 16: 118, 2016 05 24.
Article
em En
| MEDLINE
| ID: mdl-27221473
ABSTRACT
BACKGROUND:
Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics.METHODS:
Longitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors.RESULTS:
Women attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR)3.0, 95 % confidence interval (CI)2.2-4.1], two = 91 % (OR5.1, 95 % CI3.3-7.8), three = 93 % (OR6.3, 95 % CI3.1-13), four = 95 % (OR11, 95 % CI4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (ß = 6.8, 95 % CI0.25-13), nutrition counselling (ß = 8.3, 95 % CI3.1-13), and folate prescription (ß = 7.9, 95 % CI2.6-13).CONCLUSION:
Participation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care settings to improve the quality of pregnancy care.Palavras-chave
Texto completo:
1
Temas:
ECOS
/
Equidade_desigualdade
Bases de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Havaiano Nativo ou Outro Ilhéu do Pacífico
/
Melhoria de Qualidade
/
Serviços de Saúde do Indígena
/
Serviços de Saúde Materna
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
/
Pregnancy
País/Região como assunto:
Oceania
Idioma:
En
Revista:
BMC Pregnancy Childbirth
Assunto da revista:
OBSTETRICIA
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Austrália