澳大利亚维多利亚州偏远地区和农村地区以护士为主导的药物流产服务提供专家共识：德尔菲研究。

Expert consensus on a nurse-led model of medication abortion provision in regional and rural Victoria, Australia: a Delphi study.

机构信息

School of Health and Social Development, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.

Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.

出版信息

Contraception. 2019 Nov;100(5):380-385. doi: 10.1016/j.contraception.2019.07.004. Epub 2019 Jul 11.

DOI:10.1016/j.contraception.2019.07.004

PMID:31302120

Abstract

OBJECTIVE

To develop a nurse-led model of medication abortion provision for the primary health care setting of regional and rural Victoria, where, despite decriminalization, access to abortion services is restricted.

STUDY DESIGN

This study used a three-round Delphi process to explore consensus about a nurse-led medication abortion model. We recruited a panel consisting of physicians, nurses and other experts involved with or interested in medication abortion provision. The research team thematically analyzed the responses to the seven open-ended questions of the first questionnaire. In subsequent rounds, panelists rated the 83 generated statements for agreement, using feedback and statistical summaries.

RESULTS

A total of 24 panelists participated; 17 completed all three rounds. Through the iterative process, the panel reached consensus (at least 75% agreement level) on 69 statements, relating to model construction and the barriers to model implementation and their solutions. Due to current health care system restrictions we not only developed a 'fully autonomous' nurse-led model, but also a 'legally feasible' model. For nurses working in primary health settings that lack GP support we additionally constructed an 'absence of a (medication abortion supportive) general practitioner' model.

CONCLUSION

Nurse-led medication abortion provision is a recognized strategy to improve access to equitable, affordable and safe abortion services for women residing in underserved areas. The constructed models and recommendations for practice and policy can serve as a guide to expand the role of primary health care nurses in the provision of medication abortion in Victoria and beyond.

IMPLICATIONS

The findings of this study indicate that a nurse-led model of medication abortion provision is feasible in service poor areas of Victoria and that model implementation has the potential to improve abortion access. The models are adaptable for use in other settings.

摘要

目的

为维多利亚地区的初级卫生保健环境开发一种护士主导的药物流产提供模式，尽管堕胎合法化，但该地区的堕胎服务仍然受到限制。

研究设计

本研究使用三轮 Delphi 过程来探讨对护士主导的药物流产模式的共识。我们招募了一个由医生、护士和其他参与或有兴趣提供药物流产服务的专家组成的小组。研究小组对第一份问卷中的七个开放式问题的回答进行了主题分析。在随后的几轮中，小组成员使用反馈和统计摘要对 83 个生成的陈述进行了同意程度的评估。

结果

共有 24 名小组成员参与，其中 17 名完成了全部三轮。通过迭代过程，小组就 69 项声明达成了共识（至少 75%的同意水平），这些声明涉及模型构建以及实施模型的障碍及其解决方案。由于当前的医疗保健系统限制，我们不仅开发了一种“完全自主”的护士主导模式，还开发了一种“合法可行”的模式。对于在缺乏全科医生支持的初级卫生环境中工作的护士，我们还构建了一种“缺乏（支持药物流产的）全科医生”模式。