Anthony J. Reid

Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial

Background: A pregnant womans psychological health is a significant predictor of postpartum outcomes. The Antenatal Psychosocial Health Assessment (ALPHA) form incorporates 15 risk factors associated with poor postpartum outcomes of woman abuse, child abuse, postpartum depression and couple dysfunction. We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among pregnant women than providers practising usual prenatal care. Methods: A randomized controlled trial was conducted in 4 communities in Ontario. Family physicians, obstetricians and midwives who see at least 10 prenatal patients a year enrolled 5 eligible women each. Providers in the intervention group attended an educational workshop on using the ALPHA form and completed the form with enrolled women. The control group provided usual care. After the women delivered, both groups of providers identified concerns related to the 15 risk factors on the ALPHA form for each patient and rated the level of concern. The primary outcome was the number of psychosocial concerns identified. Results were controlled for clustering. Results: There were 21 (44%) providers randomly assigned to the ALPHA group and 27 (56%) to the control group. A total of 227 patients participated: 98 (43%) in the ALPHA group and 129 (57%) in the control group. ALPHA group providers were more likely than control group providers to identify psychosocial concerns (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–3.0; p = 0.02) and to rate the level of concern as “high” (OR 4.8, 95% CI 1.1–20.2; p = 0.03). ALPHA group providers were also more likely to detect concerns related to family violence (OR 4.8, 95% CI 1.9–12.3; p = 0.001). Interpretation: Using the ALPHA form helped health care providers detect more psychosocial risk factors for poor postpartum outcomes, especially those related to family violence. It is a useful prenatal tool, identifying women who would benefit from additional support and interventions.

Medico-Legal Risk in Maternal Serum Screening: Perspective of Ontario Health Care Providers

Abstract Objective: to determine whether Ontario health care providers perceived a change in their medico-legal risk since the introduction of maternal serum screening (MSS), a province-wide genetic screening programme, in July 1993. Design: cross-sectional self-reported survey. Setting: Ontario. Participants: all Ontario obstetricians (n=565), all licensed midwives (n=62) and a random sample of 2,000 family physicians were surveyed. Only those currently providing antenatal care or attending births were eligible. The response rate was 91 percent for family physicians, 76 percent for obstetricians and 78 percent for midwives. Results: thirty-three percent of family physicians and 40 percent of obstetricians perceived that their medico-legal risk had been affected by the introduction of MSS. The vast majority indicated in written comments that they felt their risk had increased. There were significant differences (p Conclusions: most of the concerns revolved around interaction with patients, and highlight die importance of clear, effective communication about complex issues. As our technology advances, we are likely to see more genetic screening tests. The concerns expressed about MSS may be applicable to such tests in the future. It will be crucial for those providing the tests to be well educated in the complexity of issues involved.