Prenatal Care in Israel: A Doctor – Nurse Dual Model

Abstract

Background: Studies have shown significantly lower risk of complications during labor following prenatal care, allowing early detection, promoting normal pregnancy and birth. In May 2013 Maccabi Health Services launched “prenatal personal care” - a dual gynecologist and nurse follow up model. Our goals were to Preserve and promote physical and mental condition of pregnant women and conduct early identification of high risk situations and intervention. Methods: The model is based on periodic visits provided by 150 designated nurses and 200 gynecologists working in collaboration. The follow up consists of 4-6 visits through pregnancy period. Additional visits provided according to woman’s health state. The intervention includes information on recommended tests, abnormal conditions, preliminary screening for depression during pregnancy (Edinburgh questionnaire) and counseling. Various communication services such as Facebook, email, phone, app and personal meetings are available. The model maintains interfaces with other health care providers such as dieticians, pelvic floor physical therapists, social workers and others. A designated computerized record was developed allowing generate and transparent follow up. Results: Prenatal care was given to 22% of pregnant women. 58% of them were vaccinated for pertussis compared to 22% in standard care. Depression screening found 0.4% positive answers to tendency for suicide, 11.5% were suspected for depression. In addition, 85.6% performed GCT test versus 74.3% with standard care. Conclusion: The model contributes to higher health outcomes and higher satisfaction among doctors, nurses and pregnant women. The service will be expanded to telehealth prenatal care allowing broader availability and accessibility for service nationwide.