Addressing the patient's agenda in the reorganization of antenatal and infant health care: experience in one general practice.

Abstract

BACKGROUND. Antenatal care is outdated and largely unevaluated. The study practice is committed to involving patients in their own health care. It was decided to use the views of patients to guide a review of antenatal and infant health services. AIM. The study, carried out in 1993, was designed to find out what patients' priorities were, and what they thought were the strengths and weaknesses in the organization and delivery of antenatal and infant health care. METHOD. A total of 52 women attending antenatal appointments were interviewed at the practice using an interview topic guide within a qualitative research framework. Fourteen parents attending a day centre with their under five-year-olds participated in two focus groups. The findings of the interviews and focus group discussions were compared. RESULTS. The interviews revealed a high level of satisfaction with midwife care, although some changes in the organization of antenatal bookings and classes were indicated. Parents expected to be seen switfly at home or at the surgery when their infant was ill, and these high expectations were not always met. There was some degree of confusion and frustration over the role of the health visitor. The views expressed in the focus groups were broadly similar to those expressed in the interviews. CONCLUSION. The findings suggested that there was considerable potential for developing the role of both the midwife and the health visitor, and integrating their work more closely in the primary health care team. Examples are given of how these findings have altered the organization and delivery of antenatal and infant health care in the practice. The study showed that finding out and acting upon the views of patients is a practical way forward in the reshaping of services.