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Cited by 230Maternal and Perinatal Health InterventionsMaternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal Healthcare

Costs and effectiveness of community postnatal support workers: randomised controlled trial

Open access
Morrell, C J.·2000·BMJ
DOI 10.1136/bmj.321.7261.593PMC PMC27472
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Abstract

OBJECTIVES: To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. DESIGN: Randomised controlled trial with six month follow up. SETTING: Recruitment in a university teaching hospital and care provided in women's homes. PARTICIPANTS: 623 postnatal women allocated at random to intervention (311) or control (312) group. INTERVENTION: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. MAIN OUTCOME MEASURE: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. RESULTS: At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. CONCLUSIONS: There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.

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Crossref · 10.1136/bmj.321.7261.593

Cites

27 of 27 references verified0 citation errors · 0 not checkable

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  • For Morrell 2000, blinding of outcome assessment was at high risk of bias.

    “Postal questionnaire follow-up.”

    From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000

    The Methods section states that postal follow-up questionnaires were issued at six weeks and six months, supporting the cited description of follow-up. The paper does not assess blinding of outcome assessment as being at high risk of bias; that is the citing authors’ judgment, not a finding reported by Morrell. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • For Morrell 2000, incomplete outcome data was at high risk of bias.

    “Intervention group (260/311) vs control group (233/312) at 6 month, control group was relatively high attrition proportion.”

    From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000

    The recruitment and follow-up table (labelled Introduction in our copy) reports six-month questionnaires from 260/311 intervention participants and 233/312 controls, confirming greater attrition in the control group. The paper does not itself assess incomplete outcome data as being at high risk of bias; that is the citing authors’ judgment based on the reported figures. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • For Morrell 2000, sequentially numbered, sealed opaque envelopes were used.

    “By sequentially numbered, sealed opaque envelopes.”

    From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000

  • For Morrell 2000, allocation concealment was at low risk of bias.

    “By sequentially numbered, sealed opaque envelopes.”

    From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000

  • For Morrell 2000, random sequence generation was at low risk of bias.

    “Random digit tables prepared in advance.”

    From Schedules for home visits in the early postpartum period (2021) · cites this paper as Morrell 2000

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Cites

1 retracted

Flagged first, then by citations

2 of the 29 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Glazener CMA, MacArthur C, Garcia J. Postnatal care: time for change. Contemp Rev Obstet 1993;5:130-6.
  2. Spiby H, Crowther S. Dutch maternity aides: a transferable model? RCM Midwives J 1999;2:20-1.
  3. Ware J, Sherbourne C. The MOS 36 item short-form health survey (SF- 36). Med Care 1992;30:473-83.
  4. Olds DL, Eckenrode J, Henderson CR, Kitzman H, Powers J, Cole R, et al. Long-term effects of home visitation on maternal life course and child abuse and neglect. JAMA 1997;278:637-43.

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Authors
Morrell, C. J.
Affiliations
University of Sheffield (GB)
Corresponding author
Morrell, C J.
Venue
BMJ
Publisher
BMJ
Published
2000-09-09
Volume
321
Issue
7261
Pages
593-598
ISSN
0959-8138 (ISSN-L)
DOI
10.1136/bmj.321.7261.593
PMC
PMC27472
OpenAlex
W2158759181
Cited by
229
References
29
Citations by year
2026: 2 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 9 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 9 · 2015: 7 · 2014: 11 · 2013: 8 · 2012: 10
FWCI
11.52
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Health Technology Assessment Programme
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
postpartum care, home visits, community midwifery, cost-effectiveness, postpartum depression, breastfeeding, patient satisfaction, NHS costs, women's health
MeSH terms
Adolescent, Adult, Allied Health Personnel, Breast Feeding, Community Health Nursing, Cost-Benefit Analysis, Female, Follow-Up Studies, United Kingdom, House Calls, Humans, Nurse Midwives, Postnatal Care, Pregnancy, Treatment Outcome, Patient Satisfaction, Depression, Postpartum

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