Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 530-1501 West Broadway, Vancouver, British Columbia, Canada V6J 4Z6.
Midwifery. 2013 Jun;29(6):646-52. doi: 10.1016/j.midw.2012.06.004. Epub 2012 Aug 3.
interprofessional primary maternity care has emerged as one potential solution to the current health human resource shortage in many developed nations. This study explores the barriers to and facilitators of interprofessional models of maternity care between physicians, nurses, and midwives in rural British Columbia, Canada, and the changes that need to occur to facilitate such models.
a qualitative, exploratory framework guided data collection and analysis.
four rural communities in British Columbia, Canada. Two rural communities had highly functional and collaborative interprofessional relationships between midwives and physicians, and two communities lacked interprofessional activities.
55 participants were interviewed and 18 focus groups were conducted with midwives, physicians, labour and delivery nurses, public health nurses, community-based providers, birthing women, administrators, and decision makers.
in models of interprofessional collaboration, primary maternity care providers - physicians, midwives, nurses - work together to meet the needs of birthing women in their community. There are significant barriers to such collaboration given the disciplinary differences between care provider groups including skill sets, professional orientation, and funding models. Data analysis confirmed that interprofessional tensions are exacerbated in geographically isolated rural communities, due to the stress of practicing maternity care in a fee-for-service model with limited health resources and a small patient caseload. The participants we spoke with identified specific barriers to interprofessional collaboration, including physician and nurses' negative perceptions of midwifery and homebirth, inequities in payment between physicians and midwives, differences in scopes of practice, confusion about roles and responsibilities, and a lack of formal structures for supporting shared care practice. Participants expressed that successful interprofessional collaboration hinged on strong, mutually respectful relationships between the care providers and a clear understanding of team members' roles and responsibilities.
interpersonal conflicts between primary maternity care providers in rural communities were underpinned by macro-level, systemic barriers to interprofessional practice. Financial, legal, and regulatory barriers to interprofessional collaboration must be resolved if there is to be increased collaboration between rural midwives and physicians. Key recommendations include policy changes to resolve differences in scope of practice and inequitable funding between rural midwives and physicians.
多专业初级产妇保健已成为许多发达国家解决当前卫生人力资源短缺问题的一种潜在方法。本研究探讨了加拿大不列颠哥伦比亚省农村地区医生、护士和助产士之间的多专业产妇保健模式的障碍和促进因素，以及需要进行哪些改变以促进这种模式。
定性、探索性框架指导数据收集和分析。
加拿大不列颠哥伦比亚省的四个农村社区。两个农村社区的助产士和医生之间有着高度功能和协作的多专业关系，而另外两个社区则缺乏多专业活动。
对 55 名参与者进行了访谈，并对 18 个焦点小组进行了调查，参与者包括助产士、医生、分娩护士、公共卫生护士、社区提供者、分娩妇女、管理人员和决策者。
在多专业合作模式中，初级产妇保健提供者 - 医生、助产士、护士 - 共同努力满足社区中分娩妇女的需求。由于护理提供者群体之间存在技能差异、专业定位和资金模式等方面的差异，这种合作存在重大障碍。数据分析证实，在地理上孤立的农村社区中，由于在服务付费模式下以有限的卫生资源和少量患者为基础从事产妇保健工作的压力，多专业紧张局势加剧。我们采访的参与者确定了多专业合作的具体障碍，包括医生和护士对助产士和家庭分娩的负面看法、医生和助产士之间的薪酬不平等、实践范围不同、角色和责任混淆以及缺乏支持共享护理实践的正式结构。参与者表示，成功的多专业合作取决于护理提供者之间的牢固、相互尊重的关系以及对团队成员角色和责任的清晰理解。
农村社区初级产妇保健提供者之间的人际冲突是由多专业实践的宏观、系统性障碍所导致的。如果要增加农村地区助产士和医生之间的合作，就必须解决多专业合作的财务、法律和监管障碍。主要建议包括政策改革，以解决农村地区助产士和医生之间实践范围和资金不公平的差异。
