Access-to-care: evidence from home-based postnatal coordinated care after hospital discharge
Open accessAbstract
BACKGROUND: Home-based postnatal care after hospital discharge has become an integral part of postnatal care. This study aimed to determine the factors relating either to individuals or the healthcare system that affect enrollment and full participation (adherence) in the French home-based postnatal coordinated care program (PRADO). METHODS: All admitted women for delivery in a French district over one year and eligible for this home-based midwifery support after hospital discharge were included (N = 4189). Both a simple probit model and a probit Heckman selection model were used. The control variables were the characteristics of the women, the municipalities, and the hospitals. RESULTS: Approximately 68% of the eligible women chose to enroll in the PRADO program, of who nearly 60% fully participated in this program. Enrollment in the program was influenced mostly by the family context, such as the woman's age at the time of her pregnancy and the number of children in the household, the woman's level of prenatal education and information about postnatal care, as well as some hospital variables such as the characteristics and organization of the maternity units. Full participation in the program was influenced by the accessibility to health professionals, particularly midwives. Furthermore, the women's level of prenatal education and information about postnatal care, as well as their accessibility to health professionals, correlated with the socioeconomic environment. CONCLUSION: While individual factors impacted enrollment in the PRADO program, only healthcare system-related factors influenced full participation in the program. A public health policy promoting home-based postnatal care could increase the women's participation by improving their level of prenatal education and information about postnatal care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of health professionals is a key factor for participation in home-based postnatal coordinated care.
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There remains a lack of consolidated evidence on nurse-led interventions in the postnatal period that require extended monitoring.
“Despite the growing number of postnatal interventions, there remains a lack of consolidated evidence on nurse-led interventions in the postnatal period that require extended monitoring.”
From Extending the continuum: Mapping post-6-week nurse/midwife-led interventions for postnatal women – A scoping review (2026) · cites this paper as Zbiri et al., 2021
The Background discusses home-based postnatal care after early discharge and the need to monitor complications, while the Methods describe a study of access to home-based midwifery support. Neither section assesses whether evidence is consolidated for nurse-led interventions requiring extended monitoring. Searches for nurse-led interventions, evidence gaps, and long-term follow-up found no passage addressing that claim. (LLM, conf=0.75)
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- Authors
- Zbiri, S., Rozenberg, P., & Milcent, C.
- Affiliations
- Université de Versailles Saint-Quentin-en-Yvelines (FR)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Zbiri, Saad
- Milcent, Carine
- Venue
- BMC Health Services Research
- Published
- 2021-10-22
- Volume
- 21
- Issue
- 1
- Pages
- 1137-1137
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC8532282
- OpenAlex
- W3207914093
- Cited by
- 8
- References
- 33
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by)
- HAL (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- health care access, midwife support, health system factors, prenatal education, regional health disparities, family environment, postpartum care
- MeSH terms
- Child, Female, Home Care Services, Hospitals, Humans, Midwifery, Patient Discharge, Postnatal Care, Pregnancy
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