Implementing an equity-focused model for early pregnancy care in general practice.

Area of Science:

• Maternal Health Equity
• General Practice Innovation
• Public Health Interventions

Background:

• Significant disparities exist in maternal health outcomes for Māori and Pacific women in Aotearoa New Zealand.
• Early pregnancy care in general practice presents a crucial opportunity to address these inequities.
• The Best Start assessment tool was introduced to facilitate timely and culturally safe care.

Purpose of the Study:

• To implement and evaluate an equity-focused early pregnancy care model using the Best Start tool.
• To enhance timely, culturally responsive support for pregnant Māori and Pacific women.
• To reduce disparities in maternal health outcomes within general practice settings.

Main Methods:

• Iterative, co-designed implementation across diverse primary care settings.
• Inclusion of modules for co-design with pregnant Māori women (hapū māmā), clinical implementation, and wrap-around services.
• Utilized mixed methods: practice data, clinical audits, and community feedback (hui).

Main Results:

• High identification rates of pregnancies (85%) and early first-trimester identification (84%).
• Successful application of the Best Start assessment tool in 79% of identified pregnancies, including 74% of Māori pregnancies.
• Identified mental health as a primary referral need (18%), with challenges noted in smoking cessation service engagement; community feedback drove improvements like warm handovers.

Conclusions:

• The Best Start model demonstrates the potential for redesigned general practice care to improve equity.
• Culturally responsive, co-designed care and systemic support are essential for success.
• Sustained investment is critical for scaling the model, particularly for Māori and Pacific women.