Improving access to primary care for Aboriginal and Torres Strait Islander babies in Western Australia. The ‘Stork’ stepped wedge randomised controlled trial.

This will be a stepped wedge cluster randomised controlled trial (RCT). The total duration of the intervention, including pilot testing is 3 years. All public WA hospitals where women can give birth (birthing hospitals) and their surrounding primary care clinics have been grouped into 22 distinct geographic clusters and are the unit of randomisation in this study . The clusters will be randomised in a ‘stepped’ (staggered) order to receive our new model of early infant primary care or to continue with current care. The study will consist of a baseline period of six months followed by four steps of six months duration. Five or six new clusters will receive the intervention at each step and all hospitals and primary care clinics will receive the intervention by the end of the third year of the study. Project staff (Midwife, Aboriginal Liaison Officer, Registered Nurse or health researcher) will be based at the birthing hospitals and will be responsible for administering all aspects of the intervention. There are three components of the intervention which will be implemented by the dedicated infant health care coordinators: 1) Hospitals – Project staff will work with birthing hospitals to understand the gaps in current infant care coordination and develop project tools that meet the local needs. This will involve one on one meetings with the manager of midwifery, midwives and nursing staff to determine gaps within the current infant care coordination process. If possible small group discussions will be arranged for staff to attend and provide feedback about the current coordination process however it is anticipated that in some hospitals this might be difficult to coordinate. 2) Families – Project staff will approach families as soon possible after birth to invite their participation in the intervention and set up a 30-60 minute meeting. During the meeting project staff will use the locally targeted care coordination process to: a) Discuss with families about their health care needs: the purpose of this discussion will be to identify any needs that are specific to a family, for example, if a mother is having trouble with breast feeding she may wish to receive some additional information and support. Or a family may live in a very remote area and have concerns about how they will travel to scheduled appointments. b) Provide information about primary care services available for the first three months of the baby’s life: a postnatal discharge pack will be provided and each piece of information explained. The pack will include information about breast feeding, emotional health and wellbeing, advice for dads, developmental milestones, parenting courses, quitting smoking, coping skills, safe sleeping, child health checks, and immunisations. During this part of the meeting families will have the opportunity to ask questions. c) Offer assistance with birth and Medicare registration forms: families will be offered the opportunity to have assistance with filling out their birth forms. This may be done at the time of the initial meeting with the family or another time might be arranged. d) Consult with families about their choice for primary care provider: families will be asked to nominate who they would prefer to see for their baby’s health checks during the first three months of life. If they don’t know or don’t have a regular care provider, suggestions will be made by the project staff member, relevant to their location of intended residence. e) Offer to notify the chosen primary care provider about the baby’s health needs: project staff will offer to contact the chosen primary care provider on behalf of the family to let them know that the birth has occurred and discuss with the care provider any important health care needs that were raised by the family (as per outlined in a) above). f) Offer assistance with health care coordination at the time of discharge from hospital: for example, project staff may contact a family’s primary care provider to request a follow up from the clinic in relation to child health check appointments and/or immunisations. 3) Primary care providers – project staff will contact a family’s chosen primary care provider via telephone to: a) Ensure they receive birth and hospital details: project staff will ask the clinic about their preferred method for receiving information about the birth, for example fax or email containing scanned documents. b) Offer tools and guidance on early infant primary care: questions will be asked about the services and information that will be available to the family. If the project staff feel that there are any gaps in the services and/or available information, necessary resources will be offered to the clinic. c) Where necessary, offer additional assistance and contact points with experienced community child health nurses, primary care networks and paediatricians.