BMJ 2000;321:593-598 ( 9 September )

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Costs and effectiveness of community postnatal support workers: randomised controlled trial

C Jane Morrell, research fellow, ^a Helen Spiby, research and development midwife, ^b P Stewart, clinical director of obstetrics and gynaecology, ^b S Walters, statistician, ^c A Morgan, research associate. ^c

^a Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, ^b Obstetrics and Gynaecology Management, Northern General Hospital, Sheffield S5 7AU, ^c Sheffield Health Economics Group, ScHARR, University of Sheffield

Correspondence to: C J Morrell J.Morrell1{at}Sheffield.ac.uk

Objectives: To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives.
Design: Randomised controlled trial with six month follow up.
Setting: Recruitment in a university teaching hospital and care provided in women's homes.
Participants: 623 postnatal women allocated at random to intervention (311) or control (312) group.
Intervention: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker.
Main outcome measure: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs.
Results: At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were £635 for the intervention group and £456 for the control group (P=0.001). At six months figures were £815 and £639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits.
Conclusions: There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.

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