Fleuren M, van der Meulen M, Wijkel D
Public Health Division, TNO Prevention and Health, Leiden, The Netherlands.
Qual Health Care. 2000 Jun;9(2):106-10. doi: 10.1136/qhc.9.2.106.
To assess the relative contribution of patient and care provider characteristics to the adherence of general practitioners (GPs) and midwives to two specific recommendations in the Dutch national guidelines on imminent miscarriage. The study focused on performing physical examinations at the first contact and making a follow up appointment after 10 days because these are essential recommendations and there was much variation in adherence between different groups of providers.
Prospective recording by GPs and midwives of care provided for patients with symptoms of imminent miscarriage.
General practices and midwifery practices in the Netherlands.
73 GPs and 38 midwives who agreed to adhere to the guidelines; 391 patients were recorded during a period of 12 months.
Adherence to physical examinations and making a follow up appointment were measured as part of a larger prospective recording study on adherence to the guidelines on imminent miscarriage. Patient and care provider characteristics were obtained from case recordings and interviews, respectively. Multilevel analysis was performed to assess the contribution of several care provider and patient characteristics to adherence to two selected recommendations: the number of recommended physical examinations at the first contact and the number of days before a follow up appointment took place.
In the multilevel model explaining variance in adherence to physical examinations, the care provider's acceptance of the recommendations was the most important factor. Severity of symptoms and referral to an obstetrician were significant factors at the patient level. In the model for follow up appointments the characteristics of the care provider were less important. Referral to an obstetrician and probability diagnosis were significant factors at the patient level.
The study showed that characteristics of both the patient and care provider contribute to the variability in adherence. Furthermore, the contribution of the characteristics differed per recommendation. It is therefore advised that the contribution of both patient and care provider characteristics per recommendation should be carefully examined. If implementation is to be successful, strategies should be developed to address these specific contributions.
评估患者和医护人员特征对全科医生（GP）和助产士遵循荷兰国家即将流产指南中两项特定建议的相对影响。该研究聚焦于首次接触时进行体格检查以及10天后安排随访预约，因为这些是重要建议，且不同医护人员群体在遵循方面存在很大差异。
全科医生和助产士对有即将流产症状患者所提供护理进行前瞻性记录。
荷兰的全科医疗诊所和助产士诊所。
73名同意遵循该指南的全科医生和38名助产士；在12个月期间记录了391名患者。
作为一项关于即将流产指南遵循情况的大型前瞻性记录研究的一部分，对体格检查的遵循情况和安排随访预约进行测量。患者和医护人员特征分别从病例记录和访谈中获取。进行多水平分析以评估若干医护人员和患者特征对遵循两项选定建议的影响：首次接触时建议的体格检查次数以及随访预约前的天数。
在解释体格检查遵循情况差异的多水平模型中，医护人员对建议的接受程度是最重要因素。症状严重程度和转诊至产科医生在患者层面是显著因素。在随访预约模型中，医护人员特征的重要性较低。转诊至产科医生和可能性诊断在患者层面是显著因素。
该研究表明患者和医护人员的特征均导致了遵循情况的差异。此外，各特征对不同建议的影响有所不同。因此建议应仔细研究每项建议中患者和医护人员特征的影响。若要成功实施，应制定策略以应对这些特定影响。
