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美国妇产科医生对心理社会需求的筛查和干预。

Screening and Intervention for Psychosocial Needs by U.S. Obstetrician-Gynecologists.

机构信息

University of California, San Francisco School of Medicine, San Francisco, California, USA.

The Henry J. Kaiser Family Foundation (KFF), San Francisco, California, USA.

出版信息

J Womens Health (Larchmt). 2022 Jun;31(6):887-894. doi: 10.1089/jwh.2021.0236. Epub 2022 Jan 6.

Abstract

To determine the psychosocial needs screening and intervention practices of obstetrician-gynecologists (OBGYNs) and elucidate characteristics associated with screening and resource availability. We administered a cross-sectional paper and online survey to 6288 U.S. office-based OBGYNs from March 18 to September 1, 2020, inquiring about screening and intervention practices for intimate partner violence, depression, housing, and transportation. We analyzed associations between demographic/practice characteristics and screening/having resources for all four needs. 1210 OBGYNs completed the survey. One hundred ninety-five OBGYNs (16%) reported their practices screened all patients for all four needs. Having resources to address all four needs (prevalence ratio [PR] = 4.39, 95% confidence interval [CI] = 3.04-6.34), working in health centers/clinics (PR = 2.22, 95% CI = 1.43-3.45), and seeing ≥50% Medicaid patients (PR = 1.62, 95% CI = 1.02-2.58) were associated with screening for all four needs. One hundred sixty-eight OBGYNs (14%) reported their practices had resources onsite to address all four needs. Working in health centers/clinics (PR = 3.99, 95% CI = 2.56-6.22), large practices (PR = 3.37, 95% CI = 1.63-6.95), Medicaid expansion states (PR = 2.60, 95% CI = 1.45-4.65), and practices with >11% uninsured patients (PR 2.30, 95% CI = 1.31-4.04) were associated with having resources onsite for all four needs. Most OBGYN practices appeared underresourced to address psychosocial needs within clinical care. Innovative financial models or collaborative care models may help incentivize this work.

摘要

为了确定妇产科医生(OBGYN)的心理社会需求筛查和干预实践,并阐明与筛查和资源可用性相关的特征。我们于 2020 年 3 月 18 日至 9 月 1 日向 6288 名美国办公室 OBGYN 进行了横断面纸质和在线调查,询问他们在亲密伴侣暴力、抑郁、住房和交通方面的筛查和干预实践。我们分析了人口统计学/实践特征与所有四种需求的筛查/资源之间的关联。1210 名 OBGYN 完成了调查。195 名 OBGYN(16%)报告说他们的做法对所有四个需求的所有患者进行了筛查。拥有解决所有四个需求的资源(患病率比 [PR] = 4.39,95%置信区间 [CI] = 3.04-6.34),在健康中心/诊所工作(PR = 2.22,95%CI = 1.43-3.45),并治疗≥50%的医疗补助患者(PR = 1.62,95%CI = 1.02-2.58)与筛查所有四个需求相关。168 名 OBGYN(14%)报告说他们的实践有现场资源来解决所有四个需求。在健康中心/诊所工作(PR = 3.99,95%CI = 2.56-6.22),大型实践(PR = 3.37,95%CI = 1.63-6.95),医疗补助扩大州(PR = 2.60,95%CI = 1.45-4.65),以及有超过 11%的未参保患者的实践(PR 2.30,95%CI = 1.31-4.04)与拥有现场资源来解决所有四个需求相关。大多数 OBGYN 实践在临床护理中解决心理社会需求的资源似乎不足。创新的财务模式或协作护理模式可能有助于激励这项工作。

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