Home-based postnatal coordinated care after hospital discharge: a PRADO French experiment

Objective: To determine the factors that affect enrollment and full participation (adherence) in the PRADO home-based postnatal coordinated care program in France after hospital discharge. Methods: A population-based retrospective study was performed using the public health insurance database for the Yvelines district in France. The study population included all affiliated women admitted for delivery and classified as low risk in 2013. These women were eligible for home-based midwifery support after their discharge from the hospital. The enrollment and full participation of the women in home-based postnatal coordinated care were modeled using a simple probit model. Full participation in the home-based postnatal coordinated care was also modeled using a probit Heckman selection model in order to assess the self-selection process of enrollment in the program. The control variables were the characteristics of the patients, the municipalities, and the hospitals. Results: 2,859 (68.3%) of the 4,189 eligible women chose to participate in the home-based postnatal coordinated care program, of whom 2,496 (59.6% of the eligible women) subsequently took part in the entire PRADO program. On the one hand, enrollment in the home-based postnatal coordinated care was influenced mostly by family context variables including the woman's age at the time of her pregnancy and the number of children in the household, the woman's level of information including prenatal education and prenatal information regarding postpartum care, as well as hospital variables including characteristics and organization of the maternity units. On the other hand, full participation in the home-based postnatal coordinated care was influenced by the accessibility to health professionals, particularly midwives. 3 Furthermore, both the woman's level of information and accessibility to health professionals correlated with the socioeconomic environment. Conclusion: Women who become pregnant at a very early or late stage of their life as well as women with low levels of prenatal education and prenatal information regarding postpartum care have a relatively low rate of participation in home-based postnatal coordinated care. A public health policy promoting awareness of prenatal as well as postnatal issues could increase the participation in this coordinated community care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of midwives is a key factor for participation in home-based postnatal coordinated care.