Low-Tech Models of Participatory Medicine: The Astounding Results of Group Prenatal Care

A signal moment in the history of this blog was the arrival in late summer of a new ally, the birthing movement, represented by Amy Romano, the blogger at Science and Sensibility, the Lamaze International blog.

Amy gets it: participatory medicine is not just about the internet – it’s about being empowered and engaged. Her first guest post, A lifetime of participatory medicine can start with maternity care, is one of my all-time favorites.

Here’s her next – a scientifically controlled study that demonstrates how being an engaged patient produces life-altering improvements that no physician intervention has achieved. The results span all demographic boundaries and didn’t involve a bit of technology. It’s exciting; please help scrutinize.

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Guest post by Amy Romano, Science and Sensibility

In the process of reposting on my blog the archives of research summaries I wrote for a Lamaze e-newsletter from 2004-2008, I came across this summary of one of my all-time favorite randomized controlled trials. (Yes, I’m a nerd and have favorite RCTs.) I thought there was no better place to repost it than here, on e-Patients.net.

Reading this summary almost 2 years after I wrote it, I am struck by how important it is to the emerging Participatory Medicine movement. As you read it, keep in mind:

  • The “intervention” – a participatory model of group prenatal care known as CenteringPregnancy – is the only prenatal intervention known to reduce the risk of preterm birth in mixed-risk populations. Preterm birth is one of the costliest conditions in our entire healthcare system, is the largest contributor to our newborn death rate, and frequently results in long-term morbidity and disability. [Please stop and read that sentence again. These results matter. —Dave]
  • Although Participatory Medicine is fueled by advances in health information technology, CenteringPregnancy is a decidedly low-tech participatory intervention.
  • Accordingly, it has been implemented with many disadvantaged populations – teens, low-income women, women who do not speak English, women in prison, and the list goes on.
  • The organization that developed the model of care is currently testing its use in other healthcare contexts, such as mother-baby care through the first year, and chronic disease care. Participatory Medicine enthusiasts interested in learning more about group care models may wish to attend the Centering Healthcare Institute’s Third National Conference on Group Healthcare February 7-9, 2010 in San Antonio, TX

I am contributing this post to next month’s Bloggers Unite in the Fight for Preemies event, sponsored by the March of Dimes, because, as one MoD representative told me recently, “We LOVE CenteringPregnancy!”

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  • had a brief a brief one-to-one encounter with the facilitating obstetrician or midwife, conducted in a semi-private area of the group space
  • conducted self-care activities such as weight checks and blood pressure monitoring and recorded the results in their own charts
  • completed self-assessment worksheets to evaluate aspects of their own wellbeing, such as nutritional status, readiness for parenting, or postpartum birth control preferences
  • participated in facilitated discussion with the other expectant parents and one or more healthcare professionals. While a specific topic was suggested each week, women themselves determined what the group discussed, shared advice, and answered eachother’s questions.
  • had access to educational materials developed by the Centering Healthcare Institute
  • shared a healthy snack with the group
  • A 33% reduction in preterm birth (10% versus 14%)
  • A 41% reduction in preterm birth among African American participants, who represented 80% of all participants (10% vs. 16%)
  • Greater likelihood of initiating breastfeeding (67% versus 55%)
  • Increased pregnancy knowledge and self-reported readiness for labor and birth
  • Higher satisfaction with their prenatal care
  • No differences in costs, despite women in the group care model having ten-times the duration of interaction with care providers over the course of their pregnancies (20 hours versus 2 hours). However, the cost analysis did not factor in NICU charges, which were likely lower in the CenteringPregnancy group.
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Posted in: maternity | positive patterns | trends & principles

 

 

Comments

14 Responses to “Low-Tech Models of Participatory Medicine: The Astounding Results of Group Prenatal Care”

  1. Subliminal says:

    What a cool post, thanks for sharing.

  2. Susannah Fox says:

    Wow, ripped from the headlines:

    Premature Births Are Fueling Higher Rates of Infant Mortality in U.S., Report Says (11/4/2009)

    http://www.nytimes.com/2009/11/04/health/04infant.html

    High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem.

    In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available…

  3. RT @SusannahFox New report on infant mortality: http://bit.ly/2MzExb :: @midwifeamy suggests a low-tech solution: http://bit.ly/oMPdb #WhyPM

  4. Amy Romano says:

    RT @SusannahFox New report on infant mortality: http://bit.ly/2MzExb @midwifeamy suggests a low-tech solution: http://bit.ly/oMPdb #WhyPM

  5. [...] Low tech interventions such as group prenatal care  that give patients a more participatory role in the birth process also have been shown to reduce premature births. [...]

  6. Amy Romano says:

    @chukwumaonyeije I would love your take on my latest e-Patients.net post http://bit.ly/3AwCQ3 – r u familiar with Centering?

  7. SusannahFox says:

    New report on infant mortality: http://bit.ly/2MzExb :: @midwifeamy suggests a low-tech solution: http://bit.ly/oMPdb #WhyPM

  8. MoDLin says:

    Yes, the March of Dimes is very much in favor of Centering Pregnancy. Thank you for mentioning the Bloggers Unite Fight for Preemies event and the need for further research in the field of premature birth.

  9. Amy Romano says:

    Here's my other #fight4preemies post – this one about preventing prematurity http://bit.ly/3AwCQ3 #WhyPM

  10. Amy Romano says:

    I wrote abt group prenatal care as a model of low-tech participatory maternity care on the e-patients blog http://bit.ly/3AwCQ3 #cims #whyPM

  11. Amy Romano says:

    @academicobgyn don't forget the effect of group prenatal care. It may not be whether a woman gets PNC, but how. http://bit.ly/3AwCQ3

  12. @MidwifeAmy I'm citing yr "low tech models of participatory care" post at @AligningForces http://is.gd/c7Lfj #healthquality

  13. @MidwifeAmy In my talk at @AligningForces your low-tech participatory study (http://is.gd/cfcB9) was a big hit. It ain't about the technol.

  14. Amy Romano says:

    RT @ePatientDave: @MidwifeAmy In my talk at @AligningForces your low-tech participatory study (http://is.gd/cfcB9) was a big hit. It ain …

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