Hinton Lisa, Dakin Francesca H, Kuberska Karolina, Boydell Nicola, Willars Janet, Draycott Tim, Winter Cathy, McManus Richard J, Chappell Lucy C, Chakrabarti Sanhita, Howland Elizabeth, George Jenny, Leach Brandi, Dixon-Woods Mary
THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Nuffield Department of Primary Health Care Sciences, Oxford University, Oxford, UK.
BMJ Qual Saf. 2024 Apr 24;33(5):301-313. doi: 10.1136/bmjqs-2021-014329.
High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it.
This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers.
Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety.
This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.
高质量的产前护理对于确保最佳分娩结局以及降低孕产妇和胎儿死亡及发病风险至关重要。新冠疫情扰乱了常规的产前护理服务，许多护理转向了远程形式。我们旨在从使用、提供和组织远程产前护理的人员的角度，描述远程产前护理的质量状况。
这项全英国范围的研究包括访谈和一项在线调查，邀请自2020年3月以来怀孕的孕妇、产科专业人员和产科服务管理人员以及系统层面的利益相关者提供自由文本回复。招募采用基于网络的方法、专业和社区网络以及有目的地选择医院。访谈记录的分析基于持续比较法。对自由文本调查回复的分析使用了研究人员开发的编码框架。
参与者包括106名孕妇以及105名医疗保健专业人员和管理人员/利益相关者。分析得出了一个与远程产前护理利益相关者最相关的质量领域框架：效率和及时性；有效性；安全性；可及性；公平与包容；以人为本、选择和连续性。参与者报告说，在这些领域中，远程护理并非简单地是积极或消极的。本质上更具事务性的护理被认为更适合远程模式，但远程护理也被视为有可能破坏信任关系和连续性的重要方面，加剧或产生新形式的结构性不平等，并给安全带来可能的风险。
本研究提供了一个临时框架，有助于构建思维、政策和实践。通过概述与远程产前护理相关的领域范围，该框架可能对指导政策、实践和研究具有价值。
