Buhler L, Glick N, Sheps S B
Ottawa-Carleton Health Department, University of British Columbia, Vancouver.
CMAJ. 1988 Sep 1;139(5):397-403.
We evaluated the prenatal care provided to 44 low-risk women by nurse-midwives (NMs) at a special clinic of a large obstetric referral hospital and a sample of 88 low-risk women attended by family physicians (FPs) in their offices. The women were matched on the basis of date of delivery, age, parity, number of previous miscarriages, gravidity, socioeconomic status and delivery after 32 weeks' gestation. The Burlington Randomized Controlled Trial criteria, which reflect community standards of care, were updated and used to assess the information, which was provided on standard provincial prenatal care forms. Scoring was carried out blindly, and interrater reliability was high. A highly significant difference was found in the proportions of NM and FP charts that were rated adequate, superior or inadequate: 77% v. 24%, 7% v. 16% and 16% v. 60% respectively. The rate at which procedures were omitted (leading to an inadequate score) in the categories of initial assessment, monitoring and management also varied between the two patient groups. These findings, even when considered in terms of several biases that may have resulted in the high proportion of NM charts rated at least adequate, suggest that NMs provide prenatal care to low-risk women that is comparable, if not superior, to the care provided by FPs.
我们评估了一家大型产科转诊医院的一家特殊诊所的助产士为44名低风险孕妇提供的产前护理，以及家庭医生在其办公室为88名低风险孕妇提供的产前护理。这些孕妇在分娩日期、年龄、产次、既往流产次数、妊娠次数、社会经济地位以及妊娠32周后分娩等方面进行了匹配。反映社区护理标准的伯灵顿随机对照试验标准进行了更新，并用于评估在省级标准产前护理表格上提供的信息。评分是盲法进行的，评分者间信度很高。在被评为 adequate、superior 或 inadequate 的助产士和家庭医生的图表比例上发现了非常显著的差异：分别为77%对24%、7%对16%和16%对60%。在初始评估、监测和管理类别中遗漏程序（导致评分不足）的发生率在两组患者中也有所不同。这些发现，即使考虑到可能导致助产士图表中至少 adequate 比例较高的几种偏差，也表明助产士为低风险孕妇提供的产前护理即使不比家庭医生提供的护理更好，也与之相当。
