全科医生为哺乳期妇女开药时的决策：一项调查的内容分析
GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey.
作者信息
Jayawickrama Hiranya S, Amir Lisa H, Pirotta Marie V
机构信息
Mother & Child Health Research, La Trobe University, Melbourne, Australia.
出版信息
BMC Res Notes. 2010 Mar 23;3:82. doi: 10.1186/1756-0500-3-82.
BACKGROUND
Many breastfeeding women seek medical care from general practitioners (GPs) for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited.
METHODS
GPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640). Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes.
RESULTS
335 (52%) GPs responded to the survey, and 253 (76%) provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%), other infections (24%) and depressive disorders (21%). The global theme that emerged was "complexity of managing risk in prescribing for breastfeeding women". The organising themes were: certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" and infant feeding decision. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression.
CONCLUSION
GPs feel that prescribing medicines for breastfeeding women is a contentious issue. They manage the risk of prescribing by gathering information and assessing the possible effects on the breastfed infant. Without evidence-based information, they sometimes recommend cessation of breastfeeding unnecessarily.
背景
许多哺乳期女性因各种健康问题向全科医生（GP）寻求医疗护理，全科医生可能会在这些会诊中考虑开药。给哺乳期母亲开药可能导致母乳喂养提前终止，或者哺乳期母亲可能因药物对婴儿的潜在风险而被拒绝用药，这两种情况都可能导致不良后果。关于影响全科医生决策的因素及其在这种情况下的观点的信息有限。
方法
2007/2008年，对在墨尔本皇家妇女医院提供共享产妇护理的全科医生进行了匿名邮寄调查（n = 640），以确定他们在药物和母乳喂养方面的知识、态度和做法。对他们关于为哺乳期女性用药决策问题的回答进行了内容分析。构建了一个具有基本主题、组织主题和全局主题的主题网络。
结果
335名（52%）全科医生回复了调查，253名（76%）提供了他们最近一次必须决定为哺乳期女性用药情况的信息。报告的病症有乳腺炎（24%）、其他感染（24%）和抑郁症（21%）。出现的全局主题是“为哺乳期女性开药时管理风险的复杂性”。组织主题包括：决策的确定性；决策的不确定性；需要可获取、一致且可靠的药物信息；共同决策；易受影响的“第三方”和婴儿喂养决策。决策是一个范围，从简单的决策，如乳腺炎的治疗，到需要多个因素考量的复杂决策。当全科医生认为问题更复杂时，例如产后抑郁症，他们在决策中会更多地寻求信息并进行协作。
结论
全科医生认为为哺乳期女性开药是一个有争议的问题。他们通过收集信息和评估对母乳喂养婴儿的可能影响来管理开药风险。在没有循证信息的情况下，他们有时会不必要地建议停止母乳喂养。
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