Abstract
Background
The objective of this study was to assess the impact of consultant presence, volume of patients seen and weekend opening on the health and cost-related outcomes associated with different Early Pregnancy Assessment Unit (EPAU) configurations.
Methods
This was an observational study with a prospective cohort design. Six thousand six hundred six pregnant women (16 years of age and over) attending EPAUs because of suspected early pregnancy complications were recruited from 44 EPAUs across the UK. The main outcome measures were quality of life, costs, and anxiety.
Results
Costs, quality of life and anxiety scores were similar across configurations with little evidence to suggest an impact of consultant presence, weekend opening or volume of patients seen. Mean overall costs varied from £92 (95% CI £85 - £98) for a diagnosis of normally developing pregnancy to £1793 (95% CI £1346 - £2240) for a molar pregnancy. EQ-5D-5L score increased from 0.85 (95% CI 0.84–0.86) at baseline to 0.91 (95% CI 0.90–0.92) at 4 weeks for the 573 women who completed questionnaires at both time points, largely due to improvements in the pain/discomfort and anxiety/depression dimensions. 78% of women reported a decrease in their anxiety score immediately following their EPAU appointment.
Conclusions
EPAU configuration, as specified in this study, had limited impact on any of the outcomes examined. However, it is clear that care provided in the EPAU has a positive overall effect on women’s health and emotional wellbeing, with significant improvements in EQ-5D and anxiety shown following an EPAU visit.
The objective of this study was to assess the impact of consultant presence, volume of patients seen and weekend opening on the health and cost-related outcomes associated with different Early Pregnancy Assessment Unit (EPAU) configurations.
Methods
This was an observational study with a prospective cohort design. Six thousand six hundred six pregnant women (16 years of age and over) attending EPAUs because of suspected early pregnancy complications were recruited from 44 EPAUs across the UK. The main outcome measures were quality of life, costs, and anxiety.
Results
Costs, quality of life and anxiety scores were similar across configurations with little evidence to suggest an impact of consultant presence, weekend opening or volume of patients seen. Mean overall costs varied from £92 (95% CI £85 - £98) for a diagnosis of normally developing pregnancy to £1793 (95% CI £1346 - £2240) for a molar pregnancy. EQ-5D-5L score increased from 0.85 (95% CI 0.84–0.86) at baseline to 0.91 (95% CI 0.90–0.92) at 4 weeks for the 573 women who completed questionnaires at both time points, largely due to improvements in the pain/discomfort and anxiety/depression dimensions. 78% of women reported a decrease in their anxiety score immediately following their EPAU appointment.
Conclusions
EPAU configuration, as specified in this study, had limited impact on any of the outcomes examined. However, it is clear that care provided in the EPAU has a positive overall effect on women’s health and emotional wellbeing, with significant improvements in EQ-5D and anxiety shown following an EPAU visit.
| Original language | English |
|---|---|
| Article number | 319 |
| Number of pages | 10 |
| Journal | BMC Health Services Research |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 9 Mar 2022 |
Bibliographical note
Funding Information:This national study has been realised thanks to the participation and hard work of 44 EPAUs and their supporting research staff and a large number of patients who took the time to complete the questionnaires. We would also like to thanks the study steering committee: Pat Doyle (chairperson), Professor in Epidemiology, London School of Hygiene and Tropical Medicine. Cecilia Bottomley, Lead Clinician for Early Pregnancy, Chelsea and Westminster Hospital. Elizabeth Bradley, GP, Hampstead Group Practice. Hannah-Rose Douglas, Research Lead for Analytical Services, NHS England. Marjory Maclean, Consultant Obstetrician and Gynaecologist, NHS Ayrshire and Arran. Brad Manktelow, Associate Statistics Professor, University of Leicester. Alex Peace-Gadsby, chairperson, The Ectopic Pregnancy Trust.
Funding Information:
This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care.
Publisher Copyright:
© 2022, The Author(s).
Keywords
- Early pregnancy
- Cohort study
- Cost-effectiveness
- Quality of life