Models of Care

Models of Care

I. The feasibility of caseload midwifery in rural Australia: A literature review (Brown & Dietsch, 2012)

The purpose of this paper was to conduct an integrative literature review to determine whether caseload midwifery is a feasible model for introducing into the rural Australian context. Four main categories were identified: evidence for caseload midwifery; applicability to the rural context; experiences of registered and student midwives; and implementation of caseload midwifery models. The authors concluded that there is evidence to support caseload midwifery and its implementation in the rural setting.

Brown, M., & Dietsch, E. (2012). The feasibility of caseload midwifery in rural Australia: A literature review. Women and Birth, Article in Press.

II. Australian maternity reform through clinical redesign (Hartz et al, 2012)

This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality, strategies and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context.

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III. Models of intrapartum care and women’s trade-offs in remote and rural Scotland: a mixed-methods study (Pitchforth et al, 2008)

The objective of this study was to explore women’s preferences for, and trade-offs between, key attributes of intrapartum care models. Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results

found women preferred delivery in a unit to home birth and preferred consultant-led care (CLC) to midwife-managed care (MMC). Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one’s preferred choice. In contrast to service redesign offering local midwifemanaged intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer.

E Pitchforth, V Watson, J Tucker, M Ryan, E van Teijlingen, J Farmer, J Ireland, E Thomson, A Kiger, H Bryers (2008)  Models of intrapartum care and women’s trade-offs in remote and rural Scotland: a mixed-methods study.   BJOG 115: 5. 560-569 Apr  

IV. National review of maternity services 2008: women influencing change (McIntyre, Francis & Champman, 2011)

A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women. Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors’ traditional authority is questioned by strong consumer organisations and informed consumers. Attention is given to the rural setting of maternity service provision.

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V. How do small rural primary health care services sustain themselves in a constantly changing health system environment?

The ability to sustain comprehensive primary health care (PHC) services in the face of change is crucial to the health of rural communities. This paper illustrates how the Elmore Primary Health Service located in rural Victoria has proactively managed change to remain sustainable. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups) and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure. The evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified.

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Delivering Continuity of Midwifery Care to Queensland Women Guide (2012)

In this document you will find details on –

  1. Why provide continuity of midwifery care?
  2. A description of Midwifery continuity models
  3. Steps in implementing a new model
  4. Key elements to successfully implementing a midwifery continuity of care model
  5. Cultural change – building a supportive cultural environment
  6. Clinical governance
  7. Costing and revenue for caseload models
  8. Industrial issues
  9. Professional development and capacity building
  10. Midwifery practice in continuity models
  11. Collaborative maternity care
  12. Sustaining and evaluating
  13. Eligible midwives

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