Accessibility, continuity and appropriateness: key elements in assessing integration of perinatal services

Area of Science:

• Healthcare Services Research
• Maternal and Child Health
• Public Health Policy

Background:

• Hospital stays post-delivery are shortening, especially in perinatal care, necessitating robust community follow-up.
• Adequate postnatal care integration between hospital and community services is crucial for maternal and neonatal health.
• This study investigates the accessibility, continuity, and appropriateness of postnatal services in Quebec.

Purpose of the Study:

• To assess postnatal service accessibility for mothers and neonates.
• To evaluate the continuity of care between hospital and community postnatal services.
• To determine if postnatal services are provided by the appropriate care source.

Main Methods:

• A telephone survey of 1158 mothers in a large urban area of Quebec, Canada.
• Comparison of survey results against widely recognized clinical guidelines.
• Analysis of service accessibility, continuity, and duplication.

Main Results:

• Low accessibility to postnatal services, with less than half of mothers receiving a nurse home visit.
• Poor continuity of care: under 10% received timely follow-up calls, and only 18% had timely home visits.
• Significant service duplication (44.7% of newborns) and gaps in care (40.7% not seen post-discharge).

Conclusions:

• Serious discrepancies exist between current postnatal practices and clinical guidelines in Quebec.
• Concerns raised regarding the integration and coordination of postnatal services between healthcare agencies.
• Factors influencing integration include strategic leadership, network structure, information systems, and collaborative relationships.