Poels M, Koster M P H, Franx A, van Stel H F
Division Woman and Baby, University Medical Center Utrecht, P.O. Box 85090, Utrecht, 3508 AB, The Netherlands.
Present Address: Department of Obstetrics and Gynecology, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands.
BMC Health Serv Res. 2017 Jan 31;17(1):92. doi: 10.1186/s12913-017-2051-4.
The attention for preconception care (PCC) has grown substantially in recent years, yet PCC is far from routine in daily practice. One of the major challenges for the implementation of PCC is to identify how it can best be organized and provided within the primary care setting. The aim of this study was to identify bottlenecks and solutions for the delivery of PCC from a healthcare providers' perspective in a local community setting in the Netherlands.
Health professionals within the region of Zeist, the Netherlands, were invited for a meeting on the local implementation of PCC. Five parallel group sessions were held with 30 participants from different disciplines. The sessions were moderated based on the Nominal Group Technique, in which bottlenecks (step 1) and solutions (step 2) for the delivery of PCC were gathered, categorized and prioritized by the participants.
Participants expressed that the provision of PCC is challenging due to lack of awareness, the absence of a costing structure and unclear allocation of responsibilities. The most pragmatic approach considered was to make interdisciplinary arrangements within the local primary care setting. Participants recommended to 1) settle a costing structure by means of third party reimbursement, 2) improve collaboration by means of a local cooperation network and an adequate referral system, 3) invest in education, tools and logistics and 4) increase uptake rates by the routine opportunistic offer of PCC and promotional campaigns.
From a provider's perspective a tailored approach is advocated in which interdisciplinary arrangements for collaboration and referral are set up within the local primary care setting.
近年来，人们对孕前保健（PCC）的关注度大幅提高，但在日常实践中，孕前保健远未成为常规。实施孕前保健的主要挑战之一是确定如何在初级保健环境中以最佳方式组织和提供该服务。本研究的目的是从荷兰当地社区环境中医护人员的角度，确定孕前保健服务提供过程中的瓶颈和解决方案。
荷兰泽斯地区的卫生专业人员受邀参加一次关于当地孕前保健实施情况的会议。来自不同学科的30名参与者参加了五场平行分组会议。会议采用名义小组技术进行主持，参与者收集、分类并确定了孕前保健服务提供过程中的瓶颈（第一步）和解决方案（第二步）的优先级。
参与者表示，由于缺乏认识、没有成本核算结构以及责任分配不明确，提供孕前保健具有挑战性。所考虑的最务实的方法是在当地初级保健环境中进行跨学科安排。参与者建议：1）通过第三方报销确定成本核算结构；2）通过当地合作网络和适当的转诊系统改善协作；3）投资于教育、工具和后勤；4）通过常规机会性提供孕前保健和宣传活动提高接受率。
从提供者的角度出发，提倡采用一种量身定制的方法，即在当地初级保健环境中建立跨学科的协作和转诊安排。
