PhD candidate Erasmus MC Rotterdam, Zuid-Holland, Netherlands
Background: Integration of home phototherapy into routine care for neonatal hyperbilirubinemia remains limited in many settings. Objective: We developed a tailored implementation strategy and evaluated its effect on implementation, service, and client outcomes. Design/Methods: In this multicentre, prospective before-after study, we implemented home phototherapy using a tailored implementation strategy across six Obstetric Care Networks (OCNs) in two regions in the Netherlands. Neonates with a gestational age ≥ 35 + 0 weeks who needed phototherapy for hyperbilirubinemia were eligible for inclusion. Data were collected before (12 months) and after (12 months) implementation, separated by a 2-month implementation period. A mixed-methods approach was used for evaluation. The primary outcome was implementation reach, defined as the proportion of neonates treated with home phototherapy among those who met the eligibility criteria. Secondary outcomes included service outcomes, e.g. readmissions after home phototherapy, and client outcomes, e.g. parental experiences. Results: Of the 146 neonates eligible for home phototherapy in the after-period, 69% (n = 97) were actually treated at home, compared with 0% (n = 0) in the before-period. Among those treated, 49 (51%) received phototherapy entirely at home, while 48 (49%) received partial home phototherapy following initial treatment in the hospital. The main reasons for not initiating home treatment were parental preferences, lack of awareness of home phototherapy among pediatricians, and the lack of reimbursement for community midwives. Healthcare professionals found home phototherapy feasible and the implementation strategies useful. All OCNs indicated the intention to continue offering home phototherapy. Only one neonate (1%) was readmitted to the hospital after receiving initial home phototherapy due to feeding problems. Among the parents who completed the questionnaire (n = 53), 97% were satisfied with home phototherapy, and 94% of parents would choose home phototherapy again.
Conclusion(s): These findings demonstrate that integrating home phototherapy into routine neonatal care through a tailored implementation strategy is feasible, safe, and acceptable.
