Smith L F, Jewell D
Department of Epidemiology and Public Health Medicine, University of Bristol.
BMJ. 1991 Jan 5;302(6767):13-6. doi: 10.1136/bmj.302.6767.13.
To ascertain the contribution of general practitioners to hospital intrapartum care in 1988.
Confidential postal questionnaire.
All maternity units in England and Wales.
Type of general practitioner unit (if any); number of bookings, transfers, and deliveries by general practitioners; participation of general practitioners in the policy and audit of the unit.
277 (93%) of 297 units replied. Of 611,644 deliveries, 36,043 (5.9%) were under general practitioner care. In all, 228 units permitted general practitioners to book women under their sole care: 65 were isolated, 29 alongside, and 134 integrated general practitioner units. Alongside units had significantly more bookings (568), antenatal transfers (69), intrapartum transfers (86), and deliveries (387) compared with isolated units (185, 18, 16, and 125, respectively) and integrated units (106, 18, 18, and 52) (p less than 0.001 for all differences). The percentage of women booked by general practitioners transferred either before or during labour was independent of both the type of unit and the number of general practitioner bookings. General practitioners in consultant units were significantly less likely to attend meetings reviewing perinatal mortality (p less than 0.01), and these units were less likely to have any form of general practitioner-consultant liaison committee (p less than 0.001) compared with general practitioner units as a whole. Compared with those in isolated and alongside units, general practitioners in integrated units were less likely to have taken part in deciding the unit's booking policy (p less than 0.01) and consultants more likely to be the final determinant of whether a general practitioner should be permitted to practice within the unit (p less than 0.001).
Both the number of deliveries booked by general practitioners and the number of isolated general practitioner units have fallen. Transfer from general practitioner to consultant care was independent of the general practitioner unit's caseload or the type of unit. General practitioner units differ from consultant units in important ways and differ among themselves as well. Except in remote areas, alongside units may be the ideal type of unit to encourage general practitioners to continue to provide intrapartum care.
确定1988年全科医生对医院产时护理的贡献。
保密邮寄问卷调查。
英格兰和威尔士的所有产科单位。
全科医生单位类型（如有）；全科医生的预约、转诊和分娩数量；全科医生参与单位政策制定和审计的情况。
297个单位中有277个（93%）回复。在611,644例分娩中，36,043例（5.9%）由全科医生护理。总共有228个单位允许全科医生独自为孕妇预约：65个是独立的，29个是附属的，134个是综合全科医生单位。与独立单位（分别为185、18、16和125例）和综合单位（106、18、18和52例）相比，附属单位的预约（568例）、产前转诊（69例）、产时转诊（86例）和分娩（387例）明显更多（所有差异p均小于0.001）。全科医生预约的孕妇在临产前或产时转诊的比例与单位类型和全科医生预约数量均无关。与整体的全科医生单位相比，顾问单位的全科医生参加围产期死亡率审查会议的可能性明显较小（p小于0.01），且这些单位设有任何形式的全科医生-顾问联络委员会的可能性较小（p小于0.001）。与独立单位和附属单位的全科医生相比，综合单位的全科医生参与决定单位预约政策的可能性较小（p小于0.01），而顾问更有可能成为是否允许全科医生在单位内执业的最终决定因素（p小于0.001）。
全科医生预约的分娩数量和独立全科医生单位数量均有所下降。从全科医生护理转为顾问护理与全科医生单位的工作量或单位类型无关。全科医生单位与顾问单位在重要方面存在差异，且它们之间也各不相同。除偏远地区外，附属单位可能是鼓励全科医生继续提供产时护理的理想单位类型。
