RESUMO
KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting.
KID-PROTEKT es una intervención en asistencia sanitaria psicosocial centrada en el niño, cuyo objetivo es mejorar la detección de las necesidades psicosociales y la navegación en un entorno ambulatorio ginecológico y pediátrico. En este ensayo clínico aleatorizado por conglomerados analizamos el efecto de KID-PROTEKT en las derivaciones (a los servicios de apoyo) en comparación con la asistencia ginecológica y pediátrica externa periódica. Se comparó una variante basada en la cualificación de los proveedores de asistencia sanitaria (tratamiento cualificado, TC) y otra variante con trabajador social (tratamiento de apoyo, TA) con la asistencia sanitaria periódica (tratamiento habitual, TH). Se aleatorizaron 24 servicios ginecológicos y pediátricos en una de las tres ramas del estudio. De este modo participaron en el estudio 8,458 mujeres gestantes y familias reclutadas en una de estas prácticas. Los pacientes participantes notificaron una media de 1.73 (DT = 1.34) riesgos psicosociales. En total se vinculó a 522 pacientes a un servicio de apoyo. En comparación con el tratamiento habitual, la probabilidad de una derivación fue significativamente elevada en el tratamiento cualificado (OR = 10.70) y de apoyo (OR = 11.28). Igualmente se vinculó un elevado número de riesgos psicosociales a una derivación (OR = 2.72). Los resultados confirman la importancia de la evaluación psicosocial en el tratamiento ginecológico y pediátrico.
RESUMO
KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting. (AU)
KID-PROTEKT es una intervención en asistencia sanitaria psicosocial centrada en el niño, cuyo objetivo es mejorar la detección de las necesidades psicosociales y la navegación en un entorno ambulatorio ginecológico y pediátrico. En este ensayo clínico aleatorizado por conglomerados analizamos el efecto de KID-PROTEKT en las derivaciones (a los servicios de apoyo) en comparación con la asistencia ginecológica y pediátrica externa periódica. Se comparó una variante basada en la cualificación de los proveedores de asistencia sanitaria (tratamiento cualificado, TC) y otra variante con trabajador social (tratamiento de apoyo, TA) con la asistencia sanitaria periódica (tratamiento habitual, TH). Se aleatorizaron 24 servicios ginecológicos y pediátricos en una de las tres ramas del estudio. De este modo participaron en el estudio 8,458 mujeres gestantes y familias reclutadas en una de estas prácticas. Los pacientes participantes notificaron una media de 1.73 (DT = 1.34) riesgos psicosociales. En total se vinculó a 522 pacientes a un servicio de apoyo. En comparación con el tratamiento habitual, la probabilidad de una derivación fue significativamente elevada en el tratamiento cualificado (OR = 10.70) y de apoyo (OR = 11.28). Igualmente se vinculó un elevado número de riesgos psicosociales a una derivación (OR = 2.72). Los resultados confirman la importancia de la evaluación psicosocial en el tratamiento ginecológico y pediátrico. (AU)
Assuntos
Humanos , Estresse Psicológico , Gravidez , Colaboração Intersetorial , GinecologiaRESUMO
BACKGROUND: Psychosocial stress can have detrimental effects on the mother's health and the development of the child. The aim of the family intervention "Babylotse ambulant" in gynecologic practices is the systematic and early identification of psychosocially distressed families as well as consulting and connecting them to the regional health and social care system. OBJECTIVES: The effectiveness of the family intervention in six gynecologic practices was investigated through a pre-post control group design using perceived self-efficacy as outcome. It was assumed that participation in the intervention would result in increased maternal self-efficacy as a measurement of faith in one's own abilities to solve problems. METHODS: Self-efficacy of n=202 psychosocially distressed and n=262 non-distressed patients, who were screened in one of the six gynaecologic practices, was assessed using the Self-Efficacy Scale during the first trimester (T0) and one year after birth (T1). RESULTS: Psychosocially distressed mothers, who all received counselling from social workers, showed a significantly higher self-efficacy at T1 compared to T0. After the intervention, no significant differences were found between distressed patients and the control group of non-distressed patients who received no intervention. DISCUSSION: Increased self-efficacy in distressed mothers after giving birth and thus, more faith in their own problem-solving capabilities points to the positive effects of the intervention during pregnancy in an outpatient gynecologic setting. CONCLUSION: Addressing psychosocial distress and strengthening self-efficacy is relevant in clinical interventions. As interface management, a pilot-based intervention like "Babylotse ambulant" can provide relief in the care of distressed patients during pregnancy and birth.
Assuntos
Autoeficácia , Apoio Social , Criança , Aconselhamento , Emoções , Feminino , Humanos , Mães , GravidezRESUMO
BACKGROUND: Due to their high social acceptance gynecologists provide ideal conditions for approaching families. Psychosocial stress (PSS), e. g. in the context of partnership conflicts, poverty or social isolation can be identified and support can be initiated. OBJECTIVES: The aim of the study was to capture attitudes and engagement of gynecologists dealing with patients with PSS in gynecological practices in Germany. METHODS: Out of 3000 randomly selected gynecologists in private practices, 1034 (response rate: 35%) took part in a Germany-wide questionnaire study on gynecologists' sense of responsibility, procedures and barriers when dealing with women with PSS. RESULTS: Ninety-six percent of the surveyed gynecologists felt responsible for patients with PSS. On average, gynecologists assumed PSS in 23% of their patients. Most of the gynecologists counseled patients with PSS and referral into the regional help system often occurred. When asked about the German early intervention system, 74% responded that they could imagine their own practice participating in this system. A need for improvement was observed in networking and financing. Significant differences in screening and interventions were found mainly in terms of professional experience, old vs. new federal states as well as between single and joint practices. CONCLUSIONS: Surprisingly, openness and engagement for patients with PSS were found in gynecological practices. The majority of gynecologists already offered psychosocial interventions. It may be deduced from these results that gynecologists in practices would contribute to the psychosocial aid network if key basic conditions including the financing were fulfilled.
