Gilbert Paul, Herzig Karen, Thakar Dhara, Viloria Joyce, Bogetz Alyssa, Danley Dale W, Jackson Rebecca, Gerbert Barbara
Division of Behavioral Sciences, Professionalism, and Ethics, University of California San Francisco, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94117, USA.
Women Health. 2007;45(2):41-57. doi: 10.1300/J013v45n02_03.
We sought to understand how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks.
We convened eight focus groups of 60 prenatal care providers to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, we conducted a re-analysis of focus group transcripts to examine systemic factors.
Practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO.
Each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings.
我们试图了解系统性因素如何促进或阻碍医疗服务提供者筛查产前行为风险并进行干预的能力。
我们召集了8个由60名产前护理提供者组成的焦点小组，以探讨评估孕妇烟草、酒精和非法药物使用情况并提供咨询的方法。由于执业环境常被提及为风险预防的诱因或障碍，我们对焦点小组记录进行了重新分析，以研究系统性因素。
执业环境对医疗服务提供者的行为有很大影响，不同环境在护理连续性、资源可用性以及对风险预防的组织支持方面存在差异。私人执业和大型健康维护组织（HMO）之间存在最显著的差异。
每种环境都有促进预防咨询的特点。了解这些系统性因素有助于在所有医疗环境中改善孕期的风险预防措施。
