Doetsch Julia Nadine, Marques Sandra C S, Krafft Thomas, Barros Henrique
EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-091, Porto, Portugal.
Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
BMC Public Health. 2021 Jan 25;21(1):210. doi: 10.1186/s12889-021-10194-0.
The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal.
A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018-July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed.
Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain.
An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.
世界卫生组织确定宏观社会经济决定因素和政治背景是影响医疗质量和健康公平性的相互关联的关键因素。作为对近期经济和金融危机的回应，葡萄牙于2011年批准了经济调整计划（EAP），以获得三驾马车的财政援助，以减少公共债务。本研究旨在分析经济危机和EAP对葡萄牙两个主要大都市地区卫生行政区内医疗专业人员和专家所认为的极早产（VPT）和/或极低出生体重（VLBW）婴儿围产期医疗质量的影响。
采用定性方法以获得深入理解并实现观点的多样性。使用了目的抽样技术。在2018年10月至2019年7月期间，对21名医疗专业人员和专家进行了半结构化访谈。进行了归纳主题分析，包括五步分类程序。利用Nvivo2011软件进行数据分析。然后将演变出的主题与世界卫生组织的孕产妇和新生儿护理质量标准相关联。建立了一个关于宏观社会经济决定因素对围产期医疗质量影响的框架。
尽管参与者并未察觉到围产期护理质量有所下降，但对他们工作经历的叙述分析表明，在世界卫生组织的所有质量标准中，围产期护理质量确实受到了不利影响。医疗服务在五个主要方面被认为是有害的：1）人力资源的可获得性；2）有效的转诊系统；3）有能力且积极主动的人力资源；4）情感支持；5）可用的基本物质资源。经济调整计划的政策改革导致护理及时性降低、等待时间增加、会诊顺序和时长缩短，以及VPT/VLBW婴儿及其母亲的后续护理存在缺陷。经济调整计划通过造成压力、倦怠、旷工和人才外流，直接影响了医疗专业人员的工作环境。
揭示了宏观社会经济决定因素与围产期医疗质量之间的相互关系。经济危机和经济调整计划对VPT/VLBW婴儿及其母亲的公平围产期医疗质量产生了不利影响。我们的研究结果强调了紧缩政策对弱势群体的负面影响。
