Accessibility, Continuity and Appropriateness: Key Elements in Assessing Integration of Perinatal Services
Référence bibliographique 
D’Amour, Danielle, Bernier, Liette, Goulet, Lise, Labadie, Jean-François et Pineault, Raynald. 2003. «Accessibility, Continuity and Appropriateness: Key Elements in Assessing Integration of Perinatal Services ». Health and Social Care in the Community, vol. 11, no 5, p. 397-404.
Intentions : « In this article, the present authors explore ways in which the health system has responded to reductions in the length of hospital stays, and what sort of integration has been achieved between the hospitals and the community sector. » (p. 398) Questions/Hypothèses : « Specifically, the present article addresses the following questions: - To what extent are postnatal services accessible to mothers and neonates? - Are postnatal services following the return home in continuity with those of the hospital? - Are the services provided by the appropriate source of care? Have the responsibilities been effectively reallocated between hospitals and CHCs [Community health center or Centre locaux de services communautaires (CLSC)]? » (p. 398)
Échantillon/Matériau : « The authors contacted 1448 mothers one month after giving birth ( ± 3 days); 1158 (80%) completed the interview. » (p. 398)
Instruments : « The authors conducted a telephone survey of mothers who gave birth in one of Montreal’s nine hospitals and who lived in one of the 29 CHC districts on the Island of Montreal (Goulet et al. 2001). » (p. 398) Type de traitement des données : Analyse de contenu et analyse statistique
« A trend toward the reduction in the length of hospital stays has been widely observed. This increasing shift is particularly evident in perinatal care. A stay of less than 48 hours after delivery has been shown to have no negative effects on the health of either the mother or the baby as long as they receive an adequate follow-up. This implies a close integration between hospital and community health services. The present article addresses the following questions: To what extent are postnatal services accessible to mothers and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the services provided by the appropriate source of care? The authors conducted a telephone survey among 1158 mothers in a large urban area in the province of Quebec, Canada. The results were compared to clinical guidelines widely recognised by professionals. The results show serious discrepancies with these guidelines. The authors found a low accessibility to services: less than half of the mothers received a home visit by a nurse. In terms of continuity of care, less than 10% of the mothers received a follow-up telephone call within the recommended time frame and only 18% benefited from a home visit within the recommended period. Finally, despite guidelines to the contrary, hospitals continue to intervene after discharge. This results in a duplication of services for 44.7% of the new-borns. On the other hand, 40.7% are not seen in the recommended period after hospital discharge at all. These results raise concerns about the integration of services between agencies. Following earlier work, the present authors have grouped explanatory factors under four dimensions: the strategic dimension, particularly leadership; the structural dimension, including the size of the network; the technological dimension, with respect to information transmission system; and the cultural dimension, which concerns the collaboration process and the development of relationships based on trust. » (p. 397)