地域医療と健康教育

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Newborn Anticipatory Guidance Delivered at Office-based vs. Home Nurse Visits

Jessica S. Beiler, Eric W. Schaefer2, Nancy Alleman3 and Ian M. Paul1

Objective: To compare anticipatory guidance delivery at primary care office and Home Nursing Visits (HNV) in the first week after birth. Methods: As part of a randomized, controlled trial comparing office-based care with a model where the initial outpatient encounter was a HNV, data were collected on visit content. During the study’s 2 week telephone interview, mothers were asked whether selected items from the textbook, Bright Futures, were covered at their initial postdischarge visit. Questions covered each of the first week anticipatory guidance categories: newborn sleep, newborn care, safety, and nutritional adequacy. Chi-squared tests were used to compare frequency of anticipatory guidance delivery between randomized groups. Results: Of the 1154 mothers enrolled, 1077 (93.3%) completed the telephone interview. Mothers in the HNV group were significantly more likely to report receiving information on anticipatory guidance topics: Infant Sleep Position (67.4% vs. 84.9%; p<.001), Umbilical Cord Care (72.8% vs.84.9%; p<.001), Fever/Temperature Taking (69.0% vs. 84.0%; p<.001), Car Seat Position (50.3% vs.64.5%; p<.001), and Feeding (82.2% vs.89.0; p<.002). Conclusions: In a comparison of two models of care after nursery discharge, significantly more mothers recalled receiving newborn anticipatory guidance at HNVs than those attending newborn office-based primary care visits.