首次产前检查期间影响医疗服务提供者遵循临床指南的患者因素。
Client Factors Affect Provider Adherence to Clinical Guidelines during First Antenatal Care.
作者信息
Amoakoh-Coleman Mary, Agyepong Irene Akua, Zuithoff Nicolaas P A, Kayode Gbenga A, Grobbee Diederick E, Klipstein-Grobusch Kerstin, Ansah Evelyn K
机构信息
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
School of Public Health, University of Ghana, Legon, Ghana.
出版信息
PLoS One. 2016 Jun 20;11(6):e0157542. doi: 10.1371/journal.pone.0157542. eCollection 2016.
BACKGROUND
The first antenatal clinic (ANC) visit helps to distinguish pregnant women who require standard care, from those with specific problems and so require special attention. There are protocols to guide care providers to provide optimal care to women during ANC. Our objectives were to determine the level of provider adherence to first antenatal visit guidelines in the Safe Motherhood Protocol (SMP), and assess patient factors that determine complete provider adherence.
METHODS
This cross-sectional study is part of a cohort study that recruited women who delivered in eleven health facilities and who had utilized antenatal care services during their pregnancy in the Greater Accra region of Ghana. A record review of the first antenatal visit of participants was carried out to assess the level of adherence to the SMP, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected using a questionnaire. Percentages of adherence levels and baseline characteristics were estimated and cluster-adjusted odds ratios (OR) calculated to identify determinants.
RESULTS
A total of 948 women who had delivered in eleven public facilities were recruited with a mean age (SD) of 28.2 (5.4) years. Overall, complete adherence to guidelines pertained to only 48.1% of pregnant women. Providers were significantly more likely to completely adhere to guidelines when caring for multiparous women [OR = 5.43 (1.69-17.44), p<0.01] but less likely to do so when attending to women with history of previous pregnancy complications [OR = 0.50 (0.33-0.75), p<0.01].
CONCLUSION
Complete provider adherence to first antenatal visit guidelines is low across different facility types in the Greater Accra region of Ghana and is determined by parity and history of previous pregnancy complication. Providers should be trained and supported to adhere to the guidelines during provision of care to all pregnant women.
背景
首次产前检查有助于区分需要标准护理的孕妇和有特殊问题因而需要特别关注的孕妇。有相关协议指导护理人员在产前检查期间为孕妇提供最佳护理。我们的目标是确定护理人员对《安全孕产协议》（SMP）中首次产前检查指南的遵守程度，并评估决定护理人员完全遵守的患者因素。
方法
这项横断面研究是一项队列研究的一部分，该队列研究招募了在加纳大阿克拉地区11家医疗机构分娩且孕期使用过产前护理服务的妇女。使用一份13项检查清单，对参与者的首次产前检查记录进行回顾，以评估对SMP的遵守程度。通过问卷调查收集她们的社会人口学特征和既往妊娠史信息。估计遵守水平的百分比和基线特征，并计算聚类调整比值比（OR）以确定决定因素。
结果
共招募了948名在11家公共机构分娩的妇女，平均年龄（标准差）为28.2（5.4）岁。总体而言，仅48.1%的孕妇完全遵守指南。护理人员在照顾经产妇时更有可能完全遵守指南[OR = 5.43（1.69 - 17.44），p<0.01]，但在照顾有既往妊娠并发症史的妇女时则不太可能完全遵守[OR = 0.50（0.33 - 0.75），p<0.01]。
结论
在加纳大阿克拉地区的不同医疗机构类型中，护理人员对首次产前检查指南的完全遵守率较低，且由产次和既往妊娠并发症史决定。应培训并支持护理人员在为所有孕妇提供护理时遵守指南。
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