BackgroundEnsuring equitable access to health care is reliant on the strengthening of primary care services. Increasing the utilisation of task-sharing and telehealth models is one strategy to improve patient access and outcomes in primary care. This protocol details the methodology of a proposed scoping review of nurse and midwife involvement in task-sharing and telehealth models in primary care.AimUndertaking this review will identify what models have been utilised in the primary care setting globally, the characteristics and health and economic outcomes of the models and whether these models are acceptable and feasible.Design and settingThis protocol was developed in line with Joanna Briggs Institute Methodology for Scoping Reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocols (PRISMA-P).Methods and analysisFive databases (Ovid MEDLINE, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library) will be searched for relevant studies published in English. Articles will be screened for inclusion in Covidence by three authors, with data extracted and synthesised using a chart designed for this review. Evidence will be mapped in both tabular and narrative forms to show characteristics, outcomes and acceptability of the models of care. Ethical approval is not required as data utilised is publicly available.ConclusionsUnderstanding how nurse and midwife-led models of care may operate is crucial to strengthening service provision in primary care. Evidence on nurse and midwife led primary care models will be collated and synthesised to inform future models
Background: Primary care-based preconception care (PCC) has the potential to improve pregnancy outcomes, but the effectiveness is unclear. Aim: To evaluate the effectiveness of primary care-based PCC delivered to reproductive-aged women and/or men to improve health knowledge, reduce preconception risk factors and improve pregnancy outcomes. Design and setting: A systematic review of primary care-based PCC. Method: We searched OVID Medline, Cochrane CENTRAL, EMBASE, Web of Science, Scopus, and CINAHL for randomized controlled trials (RCTs) published between July 1999 and May 2021. Two reviewers independently evaluated article eligibility and quality. Results: Twenty-eight articles reporting on 22 RCTs were included. All but one focused on women. Interventions included brief education (single session) (n=8), intensive education (multiple sessions) (n=9), supplementary medication (n=7) and dietary modification (n=4). Brief education improved health knowledge in women (n=3) and men (n=1), reduced alcohol/tobacco consumption (n=2) and increased folate intake (n=3). Intensive education reduced spontaneous pregnancy loss (n=1), alcohol-exposed pregnancies (n=2) and increased physical activity (n=2). Supplementary medication increased folate intake (n=4), and dietary modification reduced pre-eclampsia (n=1) and increased birthweight (n=1). Only eight articles reported on pregnancy outcomes, with a range of interventions used; of these, four reported improvements in pregnancy outcomes. Most RCTs were of low quality (n=12). Conclusion: Primary care-based PCC including brief and intensive education, supplementary medication and dietary modification are effective in improving health knowledge and reducing preconception risk factors in women, although there is limited evidence for men. Further research is required to determine whether primary care-based PCC can improve pregnancy outcomes.
BackgroundPregnancy outcomes can be adversely affected by a range of modifiable risk factors including alcohol consumption, smoking, obesity, drug use and poor nutrition during the preconception period. Preconception care (PCC) involves interventions that identify and seek to change behavioural, biomedical and social risks present in reproductive-aged women and men. Primary care is well situated to offer PCC interventions but the effectiveness of these interventions is not clear.AimTo evaluate the effectiveness of primary care-based PCC delivered to reproductive-aged women and/or men to improve health knowledge, reduce preconception risk factors and improve pregnancy outcomes.Design & settingA systematic review of primary care-based PCC.MethodOVID Medline, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, Scopus and CINAHL databases will be searched for English language studies published between July 1999 and May 2021. For inclusion, the PCC intervention must be provided in a primary care setting and intervention recipients must be reproductive-aged women and/or men. All stages of screening and data extraction will involve a dual review. The Cochrane Risk of Bias 2.0 for RCTs will be used to assess the methodological quality of studies. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and has been registered with PROSPERO (CRD42021235499).ConclusionFindings will determine the effectiveness of primary care-based preconception interventions delivered to reproductive-aged women and men on improving health knowledge, reducing risk factors and improving pregnancy outcomes. Findings will be published in a peer-reviewed journal.
For full list of author affiliations and declarations see end of paper Preconception care (PCC) is effective in reducing modifiable risk factors and optimising maternal health. Primary care services such as general practices in Australia are an appropriate setting to provide PCC. However, PCC is not routinely provided in most of these settings, and many reproductive-aged women and men are not aware of the need for PCC. In this forum article, we discuss the factors that hinder PCC provision in Australian general practices and make recommendations on how access to PCC services can be broadened in Australia, including the potential opportunity for general practice nurses to contribute to the provision of PCC.
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