Gunn Jane, Southern Donna, Chondros Patty, Thomson Philippa, Robertson Kathryn
Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.
Fam Pract. 2003 Aug;20(4):382-9. doi: 10.1093/fampra/cmg408.
Postnatal morbidity is high, and many GPs lack the confidence and knowledge to deal with common postnatal problems. There is a high consultation rate, but few women disclose common health problems.
The aim of the present study was to increase the knowledge and skills of GPs to enable them to identify and manage common health problems experienced by women in the year following childbirth.
An educational programme [Guidelines for Assessing Postnatal Problems (GAPP)] embedded within a large randomized community intervention trial [Program of Resources, Information and Support for Mothers (PRISM)] with a before/after evaluation was undergone by Australian GPs working in four metropolitan and four rural communities. The programme comprised audit, interactive workshops, role-play and evidence-based guidelines, and was evaluated at baseline and 6 months through written questionnaires and a surgery consultation with a trained simulated patient evaluator.
A total of 68 (86%) GPs took part in the full GAPP programme. The odds of a GP improving on the knowledge items ranged from 1.0 to 16, with the greatest change occurring in knowledge about the effectiveness of cognitive behavioural therapy for maternal depression. Of the GPs with an incorrect response at baseline, the percentage demonstrating improved knowledge at follow-up ranged from 22 to 100%. Around half of the GPs demonstrated excellent communication skills at baseline. Of the remaining GPs, more than half demonstrated greatly improved skills to detect common postnatal problems at follow-up. At baseline simulated patient visit, 70% of GPs inquired about sexual problems yet none inquired about the possibility of abuse, whereas at follow-up 94% inquired about sexual problems and 51.5% facilitated the disclosure of physical and emotional abuse. Anonymous feedback on the programme by participating GPs showed that 89% believed the programme positively influenced their actual practice. Interestingly, GPs demonstrated greater knowledge and skills in the simulated setting than on the written questionnaire.
This relatively brief multifaceted educational programme assisted many participants in improving their knowledge and the skills required to improve both physical and emotional health after birth. Despite being experienced clinicians and participating actively in a programme on interviewing skills, half of the GPs did not facilitate disclosure of the underlying sensitive issue (abuse) during the follow-up consultation and could benefit from further in-depth training in effective communication skills.
产后发病率很高，许多全科医生缺乏处理常见产后问题的信心和知识。咨询率很高，但很少有女性透露常见的健康问题。
本研究的目的是提高全科医生的知识和技能，使他们能够识别和管理产后一年内女性常见的健康问题。
澳大利亚在四个大都市和四个农村社区工作的全科医生参与了一项大型随机社区干预试验[母亲资源、信息和支持计划（PRISM）]中的一个教育项目[产后问题评估指南（GAPP）]，并进行前后评估。该项目包括审计、互动研讨会、角色扮演和循证指南，并通过书面问卷和与经过培训的模拟患者评估员进行的门诊咨询在基线和6个月时进行评估。
共有68名（86%）全科医生参加了完整的GAPP项目。全科医生在知识项目上提高的几率在1.0至16之间，关于认知行为疗法对产后抑郁症有效性的知识变化最大。在基线时回答错误的全科医生中，随访时知识得到改善的百分比在22%至100%之间。大约一半的全科医生在基线时表现出出色的沟通技巧。在其余的全科医生中，超过一半在随访时表现出检测常见产后问题的技能有了很大提高。在基线模拟患者就诊时，70%的全科医生询问了性问题，但没有人询问虐待的可能性，而在随访时，94%的全科医生询问了性问题，51.5%的全科医生促使患者披露身体和情感虐待情况。参与项目的全科医生对该项目的匿名反馈显示，89%的人认为该项目对他们的实际工作产生了积极影响。有趣的是，全科医生在模拟环境中表现出的知识和技能比在书面问卷中更好。
这个相对简短的多方面教育项目帮助许多参与者提高了他们的知识以及改善产后身心健康所需的技能。尽管是经验丰富的临床医生且积极参与了一个关于访谈技巧的项目，但仍有一半的全科医生在随访咨询期间没有促使患者披露潜在的敏感问题（虐待），他们可能会从进一步深入的有效沟通技能培训中受益。
