Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois, United States of America.
Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America.
PLoS One. 2018 Oct 5;13(10):e0205268. doi: 10.1371/journal.pone.0205268. eCollection 2018.
Providers need to be comfortable addressing obesity and gestational weight gain so they may give appropriate care; however, health care providers lack guidelines for the most effective educational strategies to assist in providing optimal care.
To identify studies that involved the obstetric provider in interventions for either the perinatal management of obesity and/or gestational weight gain in a systematic review.
A keyword search of databases was performed up to April 2017.
Obstetric providers who participated in an intervention with the aim to change a provider's clinical practice, knowledge, and/or satisfaction with the intervention in relation to the perinatal management of obesity or gestational weight gain were included. Provider intervention could include training or education, changes in systems or organization of care, or resources to support practice. PROSPERO database #42016038921.
Bias was assessed according to the validated Mixed Methods Appraisal Tool. The following variables were synthesized: study location and setting, provider and patient characteristics, intervention features, outcomes and efficacy, and strengths and weakness.
Of the 6,821 abstracts screened, seven studies (4 quantitative, 3 mixed-methods) with a total of 335 providers met the inclusion criteria; two of which focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics. Interventions that incorporated motivational interviewing skills (n = 2), required additional training for the research study and addressed specific knowledge deficits such as nutrition and exercise (n = 3), and interfaced with the electronic medical record (n = 1) demonstrated the greatest impact on provider outcomes. Provider reported satisfaction scores were generally favorable, but none addressed provider-level efficacy in practice change.
Given the limited number of studies, varying range of provider participation, and lack of provider-level efficacy, further evaluation of provider training and involvement in interventions for perinatal obesity or gestational weight gain is indicated to determine best practices for provider and patient outcomes.
医疗服务提供者需要熟悉肥胖症和妊娠期体重增加问题，以便为患者提供适当的医疗服务；然而，医疗服务提供者缺乏最有效的教育策略指南，无法为患者提供最佳的医疗服务。
在系统评价中，确定涉及产科医生参与干预的研究，以治疗肥胖症和/或妊娠期体重增加。
对数据库进行了关键词搜索，截至 2017 年 4 月。
参与干预措施的产科医生，其目的是改变提供者的临床实践、知识和/或对与肥胖症或妊娠期体重增加相关的围产期管理的干预措施的满意度。提供者干预措施可包括培训或教育、护理系统或组织的改变，或支持实践的资源。PROSPERO 数据库 #42016038921。
根据经过验证的混合方法评估工具评估偏倚。综合了以下变量：研究地点和环境、提供者和患者的特征、干预措施的特点、结果和效果，以及优势和劣势。
在筛选出的 6821 篇摘要中，有 7 项研究（4 项定量研究，3 项混合方法研究）符合纳入标准，共涉及 335 名提供者；其中两项研究专注于肥胖症的管理，三项研究专注于妊娠期体重增加，两项研究专注于这两个主题。将动机访谈技巧纳入干预措施（n=2）、要求研究人员进行额外培训以及解决特定的知识缺陷，如营养和运动（n=3）、与电子病历接口（n=1）的干预措施对提供者结果的影响最大。提供者报告的满意度评分通常是有利的，但没有一项研究涉及提供者在实践改变方面的疗效。
鉴于研究数量有限、提供者参与范围不同以及缺乏提供者层面的疗效，需要进一步评估提供者培训和参与治疗肥胖症或妊娠期体重增加的干预措施，以确定最佳的患者和提供者结局的实践方法。
