Fleuren M, Grol R, de Haan M, Wijkel D, Oudshoorn C
Research Centre Primary/Secondary Health Care, Academic Hospital of Vrije Universiteit Amsterdam, The Netherlands.
Qual Health Care. 1997 Jun;6(2):69-74. doi: 10.1136/qshc.6.2.69.
To determine the feasibility for midwives to adhere to Dutch national guidelines on threatened miscarriage in general practice.
Prospective recording of appointments by midwives who agreed to adhere to the guidelines on threatened miscarriage. Interviews with the midwives after they had recorded appointments for one year.
Midwifery practices in The Netherlands.
56 midwives who agreed to adhere to the guidelines; 43 midwives actually made records from 156 clients during a period of 12 months.
Adherence to each recommendation and reasons for non-adherence.
The recommendation that a physical examination should take place on the first and also on the follow up appointment was not always adhered to. Reasons for non-adherence were the midwives' criticism of this recommendation, their lack of knowledge or skills, and the specific client situation. Adherence to a follow up appointment after 10 days, a counselling consultation after six weeks, and not performing an ultrasound scan was low. Reasons for non-adherence were mainly based on the midwives' criticism of these recommendations and reluctance on the part of the client. Furthermore, many midwives did not give information and instructions to the client. It is noteworthy that in 13% of the cases the midwife's policy was overridden by the obstetrician taking control of the situation after the midwife had requested an ultrasound scan.
Those recommendations in the guidelines on threatened miscarriage that are most often not adhered to should be reviewed. To reduce conflicts about ultrasound scans and referrals, agreement on the policy on threatened miscarriage should be mutually established between midwives and obstetricians.
确定助产士在全科医疗中遵循荷兰关于先兆流产的国家指南的可行性。
对同意遵循先兆流产指南的助产士预约情况进行前瞻性记录。在助产士记录预约情况一年后对其进行访谈。
荷兰的助产实践。
56名同意遵循指南的助产士；43名助产士在12个月期间实际记录了156名客户的情况。
对每项建议的遵循情况及不遵循的原因。
关于首次预约及后续预约均应进行体格检查的建议并非总能得到遵循。不遵循的原因包括助产士对该建议的批评、知识或技能的欠缺以及具体的客户情况。10天后进行后续预约、6周后进行咨询会诊以及不进行超声扫描的遵循率较低。不遵循的原因主要基于助产士对这些建议的批评以及客户的不情愿。此外，许多助产士未向客户提供信息和指导。值得注意的是，在13%的病例中，助产士要求进行超声扫描后，产科医生控制了局面，从而推翻了助产士的策略。
应重新审视先兆流产指南中那些最常未被遵循的建议。为减少超声扫描和转诊方面的冲突，助产士和产科医生应共同就先兆流产的策略达成一致。
