Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Womens Health (Lond). 2022 Jan-Dec;18:17455057221122590. doi: 10.1177/17455057221122590.
This is a prospective observational cohort study with the objective of assessing adherence to the American College of Obstetricians and Gynecologists guidelines regarding the first prenatal visit and determining what patient and provider factors are associated with high adherence in a faculty obstetric clinic at an academic medical center.
The American College of Obstetricians and Gynecologists guidelines recommend addressing 72 topics early in prenatal care. A research assistant observed the first prenatal encounter and noted which topics were discussed during the visit. Patient and clinic characteristics were also collected. The primary outcome was the percentage of topics covered at each visit. After analyzing all encounters, patient encounters that scored above the median score were compared with encounters scoring below the median using bivariate comparisons with respect to patient and clinic characteristics. A multivariable Poisson regression model with robust error variance was performed on characteristics with a value of ⩽0.2.
Fifty-one patient encounters met inclusion criteria and the median score for topics covered was 74%. Patients with chronic disease were more likely to have a higher percentage of topics covered (odds ratio 1.67, 95% confidence interval: 0.91-3.09). Patients who completed a prenatal questionnaire were also more likely to have a higher percentage (odds ratio 2.28, 95% confidence interval: 1.00-5.15) as well as patients who had nurse-led education integrated into their visit during (odds ratio 1.82, 95% confidence interval: 1.19-2.78). Patient satisfaction had no correlation with the number of topics covered.
The number of topics to cover at the first prenatal visit has expanded creating challenges for patients and providers. Integration of prenatal questionnaires and nurse-led education has the potential to address gaps in antenatal care.
这是一项前瞻性观察队列研究，旨在评估在学术医疗中心的妇产科诊所中，遵循美国妇产科医师学会（ACOG）关于首次产前检查的指南的依从性，并确定哪些患者和提供者因素与高依从性相关。
ACOG 指南建议在产前护理早期解决 72 个主题。一名研究助理观察了首次产前就诊，并记录了在就诊期间讨论的主题。还收集了患者和诊所的特征。主要结果是每次就诊时涵盖的主题百分比。在分析了所有就诊后，将评分高于中位数的患者就诊与评分低于中位数的就诊进行比较，比较了患者和诊所特征的双变量比较。对 值 ⩽0.2 的特征进行了具有稳健误差方差的多变量泊松回归模型分析。
51 例患者就诊符合纳入标准，涵盖的主题中位数评分为 74%。患有慢性病的患者更有可能涵盖更高比例的主题（优势比 1.67，95%置信区间：0.91-3.09）。完成产前问卷的患者也更有可能涵盖更高比例的主题（优势比 2.28，95%置信区间：1.00-5.15），以及在就诊期间接受护士主导的教育的患者（优势比 1.82，95%置信区间：1.19-2.78）。患者满意度与涵盖的主题数量没有相关性。
首次产前检查要涵盖的主题数量有所增加，这给患者和提供者带来了挑战。整合产前问卷和护士主导的教育有可能解决产前护理中的差距。
