Departments of Clinical Pharmacy and of Medicine, University of California, San Francisco, CA 94143-0613, USA.
Am J Public Health. 2012 Sep;102(9):1722-8. doi: 10.2105/AJPH.2011.300549. Epub 2012 Jun 21.
We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery.
We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH) from 2004 to 2006. Using interview and medical record data, logistic regression analyses estimated the odds of cesarean delivery as a function of IPC domains.
After adjustment for demographic and reproductive factors, women at KP-WC who reported higher scores for their provider's "elicitation of patient concerns and responsiveness" were less likely to have delivered by cesarean, whereas women who reported higher scores for "empowerment and self-care" were more likely. At KP-WC, women who reported low English proficiency were less likely to have delivered by cesarean than women who reported high proficiency. At SFGH, none of the IPC measures were significant; however, younger age was associated with a lower risk of cesarean delivery, whereas higher educational attainment was associated with an increased risk.
To reduce record-high rates of cesarean delivery, more emphasis should be placed on addressing the nonmedical factors associated with operative delivery.
我们研究了医患互动过程（IPC）是否与剖宫产分娩相关。
我们对 2004 年至 2006 年间加利福尼亚州核桃溪市 Kaiser Permanente 医疗中心（KP-WC）和旧金山总医院（SFGH）的 1308 名产后女性进行了一项横断面研究。通过访谈和病历数据，逻辑回归分析估计了 IPC 各领域与剖宫产的相关性。
在调整了人口统计学和生殖因素后，KP-WC 报告其提供者在“了解患者关注问题和反应能力”方面得分较高的女性进行剖宫产的可能性较低，而报告在“赋权和自我护理”方面得分较高的女性则更有可能进行剖宫产。在 KP-WC，报告英语水平较低的女性进行剖宫产的可能性低于报告英语水平较高的女性。在 SFGH，没有任何 IPC 测量指标具有显著相关性；然而，年龄较小与剖宫产风险降低相关，而教育程度较高则与剖宫产风险增加相关。
为了降低剖宫产率的创纪录高位，应更加重视解决与手术分娩相关的非医疗因素。
