获得医疗服务的机会：医院出院后家庭为基础的产后协调护理的证据。
Access-to-care: evidence from home-based postnatal coordinated care after hospital discharge.
机构信息
EA 7285, Versailles Saint-Quentin University, Montigny-le-Bretonneux, France.
International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco.
出版信息
BMC Health Serv Res. 2021 Oct 22;21(1):1137. doi: 10.1186/s12913-021-07151-3.
BACKGROUND
Home-based postnatal care after hospital discharge has become an integral part of postnatal care. This study aimed to determine the factors relating either to individuals or the healthcare system that affect enrollment and full participation (adherence) in the French home-based postnatal coordinated care program (PRADO).
METHODS
All admitted women for delivery in a French district over one year and eligible for this home-based midwifery support after hospital discharge were included (N = 4189). Both a simple probit model and a probit Heckman selection model were used. The control variables were the characteristics of the women, the municipalities, and the hospitals.
RESULTS
Approximately 68% of the eligible women chose to enroll in the PRADO program, of who nearly 60% fully participated in this program. Enrollment in the program was influenced mostly by the family context, such as the woman's age at the time of her pregnancy and the number of children in the household, the woman's level of prenatal education and information about postnatal care, as well as some hospital variables such as the characteristics and organization of the maternity units. Full participation in the program was influenced by the accessibility to health professionals, particularly midwives. Furthermore, the women's level of prenatal education and information about postnatal care, as well as their accessibility to health professionals, correlated with the socioeconomic environment.
CONCLUSION
While individual factors impacted enrollment in the PRADO program, only healthcare system-related factors influenced full participation in the program. A public health policy promoting home-based postnatal care could increase the women's participation by improving their level of prenatal education and information about postnatal care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of health professionals is a key factor for participation in home-based postnatal coordinated care.
背景
产后出院后的家庭护理已成为产后护理的一个组成部分。本研究旨在确定与个人或医疗保健系统相关的因素，这些因素会影响参加和充分参与（依从性）法国家庭为基础的产后协调护理计划（PRADO）。
方法
在法国一个地区的一年中所有接受分娩的产妇都符合出院后接受家庭助产支持的条件（N=4189）。我们使用了简单的概率单位模型和概率单位 Heckman 选择模型。控制变量是妇女、直辖市和医院的特征。
结果
大约 68%的合格妇女选择参加 PRADO 计划，其中近 60%的妇女完全参加了该计划。参加该计划主要受家庭环境的影响，例如妇女怀孕时的年龄和家庭中的孩子数量、妇女的产前教育水平和产后护理信息，以及一些医院变量，如妇产科的特点和组织。该计划的充分参与受到卫生专业人员的可及性的影响，特别是助产士。此外，妇女的产前教育水平和产后护理信息，以及她们获得卫生专业人员的机会，与社会经济环境有关。
结论
虽然个体因素影响了 PRADO 计划的参与，但只有与医疗保健系统相关的因素才会影响该计划的充分参与。促进家庭为基础的产后护理的公共卫生政策可以通过提高妇女的产前教育和产后护理信息水平来增加她们的参与度。此外，减少区域不平等可能会产生积极影响，因为卫生专业人员的可用性是参与家庭为基础的产后协调护理的关键因素。
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