Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA.
Prehosp Disaster Med. 2010 Jan-Feb;25(1):28-33. doi: 10.1017/s1049023x00007627.
Kosovo is a post-conflict nation with an extensively damaged infrastructure, a weak primary care base, and poor maternal-child health outcomes. The Kosovo-Dartmouth Alliance for Healthy Newborns (the Alliance) sought to improve maternal and neonatal health in Kosovo by providing family medicine-based antenatal care (ANC).
The ANC Program used a modification of the World Health Organization's four-visit, prenatal care model. The program is based in family medicine and requires minimal medical equipment, such as a blood pressure cuff, fetal doppler, measuring tape, urine dipstick, and charting materials. Patient education and counseling are stressed. Women are taught about danger signs in pregnancy and establishing an emergency plan, so that they can respond promptly if complications occur. Antenatal care doctors and nurses are trained to refer women to obstetricians for deviations from normal pregnancy. The providers are taught using a "Training of Trainers" approach, building on an existing system of family medicine trainers. In order to address challenges in implementation and sustainability, microsystems methodology is used to focus on implementing change and assuring quality improvement through shared decision-making and the study of outcomes.
Based on chart reviews and direct observation, ANC providers showed mastery of the components of ANC, including physical examination, recognition and referral of high-risk pregnancies, and patient education. After an initial pilot project, Kosovo's Ministry of Health recommended this program for dissemination throughout the country. During the next year, ANC was implemented at 27 Family Medicine Centers in nine municipalities; 1,671 women were seen for a total of 3,399 visits. Currently, the Alliance's model of ANC is offered in 30% of Kosovo's municipalities.
International aid projects often lack attention to long-term sustainability. Microsystems training gives participants the tools and framework to implement and sustain change, even after international support is withdrawn.
The Alliance's model of family medicine-based ANC is simple to teach and emphasizes sustainability. It may be modified for use in different cultures and healthcare systems and offers the opportunity to improve maternal and infant health by providing low cost antenatal care, available in a woman's own community.
科索沃是一个战后国家，基础设施严重受损，基层医疗基础薄弱，母婴健康状况不佳。科索沃-达特茅斯新生儿健康联盟（联盟）试图通过提供以家庭医学为基础的产前护理（ANC）来改善科索沃的母婴健康。
ANC 项目采用了世界卫生组织四次产前护理模式的修改版。该计划以家庭医学为基础，仅需要少量医疗设备，如血压袖带、胎儿多普勒、卷尺、尿液试纸和图表材料。强调患者教育和咨询。教育妇女识别妊娠期间的危险信号并制定应急计划，以便在出现并发症时能够迅速做出反应。产前保健医生和护士接受培训，以便在出现异常妊娠时将妇女转介给妇产科医生。培训人员采用“培训培训师”方法进行培训，以现有的家庭医学培训师系统为基础。为了解决实施和可持续性方面的挑战，采用微系统方法专注于通过共同决策和研究结果来实施变革和确保质量改进。
根据图表审查和直接观察，ANC 提供者熟练掌握 ANC 的各个组成部分，包括体检、识别和转介高危妊娠以及患者教育。在最初的试点项目之后，科索沃卫生部建议在全国范围内推广该项目。在接下来的一年中，ANC 在九个市的 27 个家庭医学中心实施；共有 1671 名妇女接受了总共 3399 次就诊。目前，联盟的 ANC 模式在科索沃 30%的市提供。
国际援助项目往往缺乏对长期可持续性的关注。微系统培训为参与者提供了实施和维持变革的工具和框架，即使在国际支持撤出后也是如此。
以家庭医学为基础的 ANC 联盟模式易于教授，强调可持续性。它可以进行修改，以适应不同的文化和医疗体系，并通过提供低成本的产前护理来改善母婴健康，这种护理在妇女自己的社区中可用。
