title: Continuity of care in community midwifery.
abstract: Continuity of care is often critical in delivering high quality health care. However, it is difficult to achieve in community health care where shift patterns and a need to minimise travelling time can reduce the scope for allocating staff to patients. Community midwifery is one example of such a challenge in the National Health Service where postnatal care typically involves a series of home visits. Ideally mothers would receive all of their antenatal and postnatal care from the same midwife. Minimising the number of staff-handovers helps ensure a better relationship between mothers and midwives, and provides more opportunity for staff to identify emerging problems over a series of home visits. This study examines the allocation and routing of midwives in the community using a variant of a multiple travelling salesmen problem algorithm incorporating staff preferences to explore trade-offs between travel time and continuity of care. This algorithm was integrated in a simulation to assess the additional effect of staff availability due to shift patterns and part-time working. The results indicate that continuity of care can be achieved with relatively small increases in travel time. However, shift patterns are problematic: perfect continuity of care is impractical but if there is a degree of flexibility in the visit schedule, reasonable continuity is feasible.
authors.affiliation: Stirling Management School, University of Stirling, Stirling, FK9 4LA, UK, j.a.bowers@stir.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Bowers
authors.forename: Helen
authors.initials: H
authors.lastname: Cheyne
authors.forename: Gillian
authors.initials: G
authors.lastname: Mould
authors.forename: Miranda
authors.initials: M
authors.lastname: Page
mesh_terms: D000328:Adult; D000465:Algorithms; D003198:Computer Simulation; D003266:Continuity of Patient Care; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008880:Midwifery; D062209:Patient Handoff; D011181:Postnatal Care; D011247:Pregnancy; D011787:Quality of Health Care; D013997:Time Factors; D014195:Travel; D016526:Workload