School of Medicine Sydney, Rural Clinical School (Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia.
Aust J Rural Health. 2022 Aug;30(4):512-519. doi: 10.1111/ajr.12867. Epub 2022 Apr 5.
There is public concern regarding rural workforce shortages and closure of smaller obstetric centres.
To identify whether safety is a concern for Murrumbidgee hospitals that fit primary medical care models and ascertain general practitioner (GP) obstetricians' perspectives regarding the benefits and challenges to practising in the region.
Mixed-method retrospective analysis of selected outcomes in the NSW Mothers and Babies Reports 2012-2015 and semi-structured interviews with GP obstetricians.
Murrumbidgee Local Health District.
Evaluation of the safety of smaller hospitals (i.e. discharge status at birth, neonatal resuscitation and admission to intensive care); and iterative thematic analysis.
This study provides evidence that smaller hospitals are providing safe obstetric care. Fewer babies were transferred, with fewer stillbirths, at the smaller hospitals and no difference in newborn deaths. There were more normal vaginal births in the smaller hospitals (70.0%) than in Wagga Wagga Base Hospital (57.2%) or Griffith Base Hospital (58.6%). There were fewer neonatal resuscitations in the smaller hospitals than in Wagga Wagga Base Hospital or Griffith Base Hospital. More than one-quarter of babies were admitted into the special care/neonatal intensive care for both Wagga Wagga and Griffith Base Hospitals; however, the rate was <3% in the smaller hospitals (p < 0.001). GPs were overwhelmingly positive about the professional rewards of GP obstetric practice and the importance of continuity of care, despite barriers such as workforce shortages, loss of facilities and other staff (midwives and anaesthetists). Possible solutions included fostering support systems, proactive succession planning and improving training support.
GP obstetricians are providing a valuable, safe service in MLHD with both personal and community benefits.
公众对农村劳动力短缺和较小产科中心关闭感到担忧。
确定符合初级医疗保健模式的默伦比奇地区医院是否存在安全问题，并确定全科医生（GP）产科医生对在该地区执业的好处和挑战的看法。
对 2012-2015 年新南威尔士州母婴报告中的部分结果进行混合方法回顾性分析，并对 GP 产科医生进行半结构化访谈。
默伦比奇地方卫生区。
评估较小医院（即出生时的出院情况、新生儿复苏和入住重症监护病房）的安全性；以及迭代主题分析。
本研究提供了证据表明较小的医院提供安全的产科护理。较小的医院中，婴儿转移的数量减少，死产减少，新生儿死亡没有差异。较小的医院中正常阴道分娩的比例（70.0%）高于沃加沃加基础医院（57.2%）或格里菲斯基础医院（58.6%）。较小的医院中新生儿复苏的次数少于沃加沃加基础医院或格里菲斯基础医院。超过四分之一的婴儿被送往沃加沃加和格里菲斯基础医院的特殊护理/新生儿重症监护病房；然而，较小的医院的这一比例<3%（p<0.001）。全科医生对全科医生产科实践的专业回报以及连续性护理的重要性给予了压倒性的肯定，尽管存在劳动力短缺、设施和其他工作人员（助产士和麻醉师）流失等障碍。可能的解决方案包括培养支持系统、积极的继任计划和改善培训支持。
GP 产科医生在默伦比奇地方卫生区提供了有价值的、安全的服务，对个人和社区都有好处。
