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基于教育和远程协助的模式对哥伦比亚10个农村地区产科急诊管理的影响。

Effect of a model based on education and teleassistance for the management of obstetric emergencies in 10 rural populations from Colombia.

作者信息

Escobar María Fernanda, Echavarria María Paula, Gallego Juan Carlos, Riascos Natalia, Vasquez Hilda, Nasner Daniela, Pabon Stephanie, Castro Zindy Alexandra, Cardona Didier Augusto, Castro Ana Milena, Ramos Isabella, Hincapie María Antonia, Kusanovic Juan Pedro, Martínez-Ruíz Diana Marcela, Carvajal Javier Andrés

机构信息

High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.

Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia.

出版信息

Digit Health. 2022 Oct 2;8:20552076221129077. doi: 10.1177/20552076221129077. eCollection 2022 Jan-Dec.

Abstract

INTRODUCTION

Pregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia.

METHODS

A quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL).

RESULTS

A total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease.

CONCLUSION

The implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.

摘要

引言

低收入和中等收入国家农村地区的孕妇及医疗服务提供者在获得高质量产科护理方面面临诸多问题。本研究旨在确定在哥伦比亚西南部地区一家高复杂性医院与10家低复杂性医院之间实施基于教育和远程护理的模式后,孕产妇和围产期指标的变化情况。

方法

2017年至2019年进行了一项具有历史对照组且无前测的准实验研究,通过10个初级保健中心向转诊中心(瓦莱德尔利利基金会,FVL)提供远程协助,对产科急诊护理前后的情况进行比较。

结果

在实施远程协助之前共治疗了470例患者,实施之后治疗了154例患者。项目实施后,孕产妇临床指标显示,因产科急诊转诊的产科患者数量减少了65%。通过改良早期产科预警系统评分在入院时测量的孕产妇疾病严重程度有所下降。

结论

在低复杂性医院和三级护理中心之间实施基于教育和远程协助的模式,使一些指标发生了变化,这些变化反映出农村地区获得的医疗服务增多、入院时发病率降低以及急诊事件总数减少。

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