Pregnancy wellness program's collaborative approach to prenatal care: Initial medical provider and patient satisfaction

Amanda Rose Hitchings (2004)

The Pregnancy Wellness Program (PWP) was developed in The Cheshire Medical Center (TCMC), Dartmouth-Hitchcock, Keene, New Hampshire, to address the biopsychosocial needs of an at-risk prenatal population. The primary goal of the project was to develop a collaborative prenatal program. One hundred and five adolescents and adults received services within PWP in 3 years. The program was developed on the basis of a literature review of the physical development of pregnancy, the biopsychosocial factors contributing to antepartum and postpartum complications, and the psychological factors of at-risk pregnancy. The second goal was to evaluate the satisfaction of providers and patients with PWP. The satisfaction evaluation included four components: (a) a 1-year satisfaction interview with 10 care providers; (b) a 2-year follow-up satisfaction interview with the same care providers; (c) a descriptive analyses of characteristics of 87 eligible patients; and (d) post-treatment patient satisfaction (n = 39) using the Client Satisfaction Questionnaire (Larsen, Attkisson, Hargreaves, & Nguyen, 1979), patient perception of clinician credibility (n = 39) using the Counselor Effectiveness Rating Scale (Atkinson & Carskaddon, 1975), and patient open-ended statements on the effectiveness of services. Patients reported severe problems during their pregnancies. Emotional problems were identified most frequently, followed by social problems. When social problems were the primary concern, they were often comorbid with emotional problems. At intake, most patients reported high motivation to change, but lacked confidence to change. Habitual problems (e.g., smoking cessation) were infrequently reported, even though approximately 1/3 of the sample smoked cigarettes. Providers and patients reported high satisfaction with PWP. Providers perceived the program to be effective in addressing the psychosocial needs of their patients, in reducing their patient load, and in being a potential money-saver for the clinic. A majority of the patients expressed overall satisfaction with PWP and a desire for PWP to continue. The PWP clinician was perceived as highly credible and as a good fit for their needs. Patients reported in open-ended statements increased confidence in changing their health status. Participants suggested the expansion of services like PWP to the entire scope of OBGyn needs, such as menopause, incontinence, postpartum, and infertility. Using these findings, future directions for program evaluation are provided.