Costs and effectiveness of community postnatal support workers: randomisedcontrolled trial

Objectives To establish the relative cost effectiveness of postnatal suppor t in the community in addition to the usual care provided lay community mid wives. 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 thr ee hours duration by a community postnatal support worker. Main outcome measure General health status as measured by the SF-36 and ris k of postnatal depression. Breast feeding rates, satisfaction with care, us e 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 pound 635 for the intervention group and pound 456 for the contr ol group (P = 0.001). At six months figures were pound 815 and pound 639 (P = 0.001). There were no differences between the groups in use of social se rvices or personal costs. The women in the intervention group were very sat isfied with the support worker visits. Conclusions There was no health benefit of additional home visits by commun ity postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over s ix months after the introduction of the community postnatal support worker service.