Chen Haihong, Tang Yuqing, Liu Chenxi, Liu Junjie, Wang Kang, Zhang Xinping
1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030 Hubei Province China.
2School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China.
Arch Public Health. 2020 May 8;78:41. doi: 10.1186/s13690-020-00423-0. eCollection 2020.
Hypertensive disorders of pregnancy (HDPs) are a major contributor to maternal mortality worldwide, and drug therapy for HDPs is complicated and special. Clinical guidelines help physicians optimize the care for HDPs, but little is known about whether physicians adhere to drug therapy guidelins well, especially in China. This study aims to evaluate adherence to the drug therapy guidelines of the Chinese Obstetricians and Gynecologists Association (COGA) for HDPs and to explore the corresponding associations with recommendation evidence.
A cross-sectional design was executed for 306 women with HDPs hospitalized in a maternity ward of a tertiary hospital from August 2014 to July 2015 in Hubei, China. Adherence to the COGA guidelines was evaluated according to six items: the time of use and route of administration and dosage of antihypertensive drugs, MgSO, and corticosteroids. Binary logistic regression was adopted to explore the associations between adherence to clinical decisions and recommendation evidence.
The average adherence rate for drug therapy for HDPs was 48.22%. The adherence rate for the time of antihypertensive drug and corticosteroid use scored 95.65 and 86.75%, whereas the other four items of the time of MgSO use and the routes of administration and dosages of antihypertensive drugs, MgSO, and corticosteroids scored < 50.00%. High- and low-evidence-based recommendations were followed in 40.00 and 54.70% of the decisions, respectively. Logistic regression revealed that recommendation evidence (OR = 0.588, = 0.003) was associated with adherence.
Further improvement is still needed to achieve good adherence, especially regarding the time of MgSO use and drug dosage. High-evidence-based management of drug therapy for HDPs should be strengthened.
妊娠期高血压疾病（HDPs）是全球孕产妇死亡的主要原因之一，HDPs的药物治疗复杂且特殊。临床指南有助于医生优化HDPs的治疗，但对于医生是否严格遵循药物治疗指南，尤其是在中国，了解甚少。本研究旨在评估中国妇产科医师协会（COGA）关于HDPs药物治疗指南的遵循情况，并探讨其与推荐证据的相应关联。
采用横断面设计，对2014年8月至2015年7月在中国湖北省一家三级医院产科病房住院的306例HDPs患者进行研究。根据六项内容评估对COGA指南的遵循情况：降压药物、硫酸镁和糖皮质激素的使用时间、给药途径和剂量。采用二元逻辑回归分析探讨临床决策遵循情况与推荐证据之间的关联。
HDPs药物治疗的平均遵循率为48.22%。降压药物和糖皮质激素使用时间的遵循率分别为95.65%和86.75%，而硫酸镁使用时间以及降压药物、硫酸镁和糖皮质激素的给药途径和剂量的其他四项内容的遵循率均<50.00%。分别有40.00%和54.70%的决策遵循了高证据和低证据的推荐。逻辑回归显示，推荐证据（OR = 0.588，P = 0.003）与遵循情况相关。
仍需进一步改进以实现良好的遵循，尤其是在硫酸镁使用时间和药物剂量方面。应加强对HDPs药物治疗的高证据管理。
