Petrou S, Kupek E, Vause S, Maresh M
National Perinatal Epidemiology Unit, Institute of Health Sciences, University of Oxford, UK.
Soc Sci Med. 2001 Apr;52(7):1123-34. doi: 10.1016/s0277-9536(00)00212-4.
The objective of this study was to measure the independent effects of clinical factors and non-clinical factors, such as provider and sociodemographic characteristics, on the number of antenatal visits made by women in England and Wales. The study was based on a survey of the secondary case records of 20,771 women with singleton pregnancies who were delivered between 1 August 1994 and 31 July 1995. The women in the survey attended one of nine maternity units in Northern England and North Wales selected within those areas to reflect geographical variations, as well as variations in the size and teaching status of the institution. A multivariate Poisson regression model was developed to examine differences in the number of antenatal visits made by women with different clinical and non-clinical characteristics. After controlling for non-clinical factors, primiparous women identified as high risk at booking made 1.0% more visits than primiparous women identified as low risk at booking (p = 0.196). Multiparous women identified as high risk at booking made 3.5% more visits than their low risk counterparts (p<0.001). High risk-defining criteria during antenatal care led to a 0.3% weekly increase in the number of antenatal visits amongst primiparous women (p <0.001) and a 0.4% weekly increase in the number of antenatal visits amongst multiparous women (p < 0.001). Several notable results, not reported elsewhere in the literature, were revealed by the regression analyses. After all independent variables were controlled for, women who were booked into urban teaching hospitals made 10% fewer antenatal visits than the women who were booked into the urban non-teaching hospitals. Women of Pakistani origin made 9.1% fewer antenatal visits than women of white British origin. Similar results were revealed for women of Indian origin and women from other ethnic groups. Non-smokers made 6.0% more antenatal visits than smokers. The planned pattern of antenatal care, number of carers seen, gestation at first presentation and maternal age also had significant independent impacts on the number of antenatal visits. The study highlights the sizeable impact of non-clinical factors on the antenatal care delivery process and indicates ways in which variations in antenatal care might be reduced.
本研究的目的是衡量临床因素和非临床因素（如医疗服务提供者及社会人口学特征）对英格兰和威尔士女性产前检查次数的独立影响。该研究基于对1994年8月1日至1995年7月31日期间分娩的20,771名单胎妊娠女性的二次病例记录进行的调查。参与调查的女性来自英格兰北部和北威尔士的九个产科单位之一，这些单位是在上述地区内挑选出来的，以反映地理差异以及机构规模和教学状况的差异。构建了一个多元泊松回归模型，以研究具有不同临床和非临床特征的女性产前检查次数的差异。在控制了非临床因素后，孕早期被确定为高危的初产妇比孕早期被确定为低危的初产妇产前检查次数多1.0%（p = 0.196）。孕早期被确定为高危的经产妇比其低危同行产前检查次数多3.5%（p<0.001）。产前护理期间的高危定义标准导致初产妇产前检查次数每周增加0.3%（p <0.001），经产妇产前检查次数每周增加0.4%（p < 0.001）。回归分析揭示了一些文献中未在其他地方报道的显著结果。在控制了所有自变量后，在城市教学医院建档的女性比在城市非教学医院建档的女性产前检查次数少10%。巴基斯坦裔女性比英国白人女性产前检查次数少9.1%。印度裔女性和其他族裔女性也有类似结果。不吸烟者比吸烟者产前检查次数多6.0%。产前护理的计划模式、就诊护理人员数量、首次就诊时的孕周和产妇年龄也对产前检查次数有显著的独立影响。该研究突出了非临床因素对产前护理提供过程的重大影响，并指出了减少产前护理差异的方法。
