He Korowai Manaaki Hawkes Bay: A Research Project of Pregnant Women to Test Whether Extra Free GP Appointments and a Way of Better Connecting Support Services Helps to Keep Infants Healthy.

Participating in the study involves primary care practice groups being informed about the study and consenting to take part. For those randomized to the intervention arm of the RCT, primary care practice providers will be trained to carry out the augmented best practice maternity-care pathway to any pregnant woman seeking the provider’s care services during the study period through to the baby being aged 6 weeks. An advanced form called Pregnancy Wraparound Care (PWC) has been designed to support the appointments with pregnant women and uploaded to the computer systems of the four intervention primary care practices involved in the study. It supports referrals to allied services and prompts best practice with assessment prompts, health screening prompts, education resources, recall suggestions and connections for a wraparound service. Intervention primary care practices are offered training and education refreshers sessions which cover utilization of the advanced form and education around the wraparound care pathway through lectures and Power Point presentations. The first 1 hour session takes place just prior to the intervention pathway commencing followed by two more 1-2 hour sessions over the following four months. These are presented by a team including the university researcher, project manager and relevant specialist practitioners (e.g. obstetricians). Additional sessions are available for new primary care staff at the request of each practice. During the intervention period clinicians will provide added services for pregnant women. Additional to standard maternity care the pregnant woman in this intervention pathway will be offered: 1. First Touch extended antenatal appointment and Whanau focus needs assessment - face to face appointment with primary care provider - 30 to 40 minute appointment 2. Follow-up appointment to consider test results (ordered at First Touch) and follow on from discussions and referrals made from the Whanau focus needs assessment - face to face appointment with same practitioner that First Touch was undertaken by - 20 minute appointment 3. 3rd trimester GP visit - discussion of contraception planning, possible vaccination scheduling (flu and pertussis) if not received by this time, maternal wellness (including mental health) planning for delivery and infant care following the birth and General Practice care for the infant (midwife welcome to attend) - 20 to 30 minute appointment 4. 6-week postnatal GP visit - contraception delivery if not yet received and wanted by the woman, maternal wellness (including mental health) - 20 to 30 minute appointment First Touch is an extended first antenatal appointment which includes a whanau focus needs assessment covering oral health, transport, support, housing, finances, vaccinations and education. Identified issues will be addressed by connecting the woman and whanau to existing services and support through this pathway. The pregnant woman will be booked with a midwife at this appointment. At the Follow-Up appointment - undertaken by the same practitioner group that met the woman at First Touch, results from tests ordered at First Touch will be reviewed and discussed, and a follow-on conversation from discussions and referrals made from the Whanau focus needs assessment will take place - 20 minute appointment At the 3rd Trimester GP appointment (midwife may also attend) discussion points from First Touch will be revisited, condition of mum and baby updated and looking ahead, advice given about delivery and baby's first few weeks. Education and information about early childhood education (ECE), breastfeeding, immunisations, oral health, safe sleep and contraception requirements will also be shared and planned. Maternal vaccinations will be available. A further appointment to the GP will be arranged for when the baby is 6 weeks of age open to the mother, baby and whanau. This visit will include the baby's 6 week child checks plus discussion of maternal factors such as the planned contraception and any support or navigation required from the whanau focus in pregnancy. Any unmet needs will be documented by the primary care providers. Intervention adherence will not be assessed or collected by the individual practitioners - the individual care centre may audit this themselves if warranted