Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A randomized controlled trial in Canada.
BACKGROUND
The addition of supplementary prenatal support may improve the health and well-being of high-risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community-based population of pregnant women.


METHODS
Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling).


RESULTS
Overall, those in the nurse intervention group were more likely to attend an "Early Bird" prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy-related topics but had little impact on resource use for mental health and poverty-related needs. Among those with added support, resource use among low-risk women was generally greater than among high-risk women.


CONCLUSIONS
Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community-based resources. This finding was true even for high-risk women, although this intervention did not reduce the difference in resource use between high- and low-risk women.
Tough
Suzanne C
SC
Department of Paediatrics, University of Calgary, Canada.
Johnston
David W
DW
Siever
Jodi E
JE
Jorgenson
Gayleen
G
Slocombe
Linda
L
Lane
Carolyn
C
Clarke
Margaret
M
D000328:Adult; D002170:Canada; D003152:Community Health Nursing / Q000379:methods* / Q000706:statistics & numerical data; D003150:Community Health Workers; D003376:Counseling; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006699:Home Care Services; D006801:Humans; D009313:National Health Programs; D016487:Parenting; D010353:Patient Education as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data*; D039401:Prenatal Nutritional Physiological Phenomena; D012307:Risk Factors; D019472:Universal Health Insurance