危地马拉基于模拟的产后出血管理培训的混合方法评估。
Mixed methods evaluation of simulation-based training for postpartum hemorrhage management in Guatemala.
机构信息
Stanford University Medical Center, Stanford, CA, HH333, USA.
Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA.
出版信息
BMC Pregnancy Childbirth. 2022 Jun 24;22(1):513. doi: 10.1186/s12884-022-04845-2.
BACKGROUND
To assess if simulation-based training (SBT) of B-Lynch suture and uterine balloon tamponade (UBT) for the management of postpartum hemorrhage (PPH) impacted provider attitudes, practice patterns, and patient management in Guatemala, using a mixed-methods approach.
METHODS
We conducted an in-country SBT course on the management of PPH in a governmental teaching hospital in Guatemala City, Guatemala. Participants were OB/GYN providers (n = 39) who had or had not received SBT before. Surveys and qualitative interviews evaluated provider knowledge and experiences with B-Lynch and UBT to treat PPH.
RESULTS
Multiple-choice surveys indicated that providers who received SBT were more comfortable performing and teaching B-Lynch compared to those who did not (p = 0.003 and 0.005). Qualitative interviews revealed increased provider comfort with B-Lynch compared to UBT and identified multiple barriers to uterine balloon tamponade implementation.
CONCLUSIONS
Simulation-based training had a stronger impact on provider comfort with B-Lynch compared to uterine balloon tamponade. Qualitative interviews provided insight into the challenges that hinder uptake of uterine balloon tamponade, namely resource limitations and decision-making hierarchies. Capturing data through a mixed-methods approach allowed for more comprehensive program evaluation.
背景
为了评估基于模拟的培训（SBT）对布伦希缝线和子宫球囊压迫法（UBT）在处理产后出血（PPH）方面对危地马拉提供者的态度、实践模式和患者管理的影响，我们采用了混合方法。
方法
我们在危地马拉首都危地马拉城的一家政府教学医院进行了一项关于 PPH 管理的国内 SBT 课程。参与者是 OB/GYN 提供者（n=39），他们之前是否接受过 SBT。调查和定性访谈评估了提供者对 B-Lynch 和 UBT 治疗 PPH 的知识和经验。
结果
多项选择题调查表明，接受 SBT 的提供者在执行和教授 B-Lynch 方面比未接受 SBT 的提供者更有信心（p=0.003 和 0.005）。定性访谈显示，与 UBT 相比，提供者对 B-Lynch 的信心增加，并确定了阻碍子宫球囊压迫法实施的多个障碍。
结论
与 UBT 相比，基于模拟的培训对提供者使用 B-Lynch 的信心影响更大。定性访谈深入了解了阻碍子宫球囊压迫法应用的挑战，即资源限制和决策层次结构。通过混合方法收集数据可以更全面地评估项目。
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