Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study

Autor: Louise M. Howard, Kylee Trevillion, Laura Potts, Margaret Heslin, Andrew Pickles, Sarah Byford, Lauren E. Carson, Clare Dolman, Stacey Jennings, Sonia Johnson, Ian Jones, Rebecca McDonald, Susan Pawlby, Claire Powell, Gertrude Seneviratne, Rebekah Shallcross, Nicky Stanley, Angelika Wieck, Kathryn M. Abel
Jazyk: angličtina
Rok vydání: 2022
Předmět:
ISSN: 0007-1250
Popis: BackgroundPsychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown.AimsWe hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)).MethodQuasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother–infant interaction quality and safeguarding outcome.ResultsOf 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86–1.04, P = 0.29; an absolute difference of −5%, 95% CI −14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes.ConclusionsWe found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
Databáze: OpenAIRE