D. Mitchell, MD, UPMC Internal Medicine Residency Program, Pittsburgh, Pennsylvania.
L. Lesoon, PhD, School of Rehabilitation and Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Rheumatol. 2023 Feb;50(2):240-245. doi: 10.3899/jrheum.220217. Epub 2022 Nov 1.
Rheumatologists have identified challenges to providing sexual and reproductive health (SRH) care to patients with gestational capacity. We conducted focus groups with rheumatologists and rheumatology advanced practice providers (APPs) to elicit their solutions to overcoming barriers to SRH care.
Qualitative focus groups were conducted with rheumatologists (3 groups) and APPs (2 groups) using videoconferencing. Discussions were transcribed and 2 trained research coordinators developed a content-based codebook. The coordinators applied the codebook to transcripts, and discrepancies were adjudicated to full agreement. The codes were synthesized and used to conduct a thematic analysis. Differences in codes were also identified between the clinician groups by provider type.
A total of 22 clinicians were included in the sample, including 12 rheumatologists and 10 APPs. Four themes emerged: (1) clinicians recommended preparing patients to engage in SRH conversations before and during clinic visits; (2) consultation systems are needed to facilitate rapid SRH care with women's health providers; (3) clinicians advised development of training opportunities and easy-to-access resources to address SRH knowledge gaps; and (4) clinicians recommended that educational materials about SRH in the rheumatology context are provided for patients. Although similar ideas were generated between the APP and rheumatologist groups, the rheumatologists were generally more interested in additional training and education, whereas APPs were more interested in electronic health record prompts and tools.
Providers identified many potential solutions and facilitators to enhancing SRH care in rheumatology that might serve as a foundation for intervention development.
风湿病学家已经确定了为有生育能力的患者提供性健康和生殖健康（SRH）护理的挑战。我们对风湿病学家和风湿病学高级实践提供者（APP）进行了焦点小组讨论，以了解他们克服 SRH 护理障碍的解决方案。
使用视频会议对风湿病学家（3 组）和 APP（2 组）进行了定性焦点小组讨论。对讨论内容进行了转录，并且 2 名经过培训的研究协调员开发了一个基于内容的代码本。协调员将代码本应用于转录本，并对差异进行裁决以达成完全一致。对代码进行了综合分析，并用于进行主题分析。还根据提供者类型在临床医生组之间确定了代码的差异。
共有 22 名临床医生纳入样本，包括 12 名风湿病学家和 10 名 APP。出现了 4 个主题：（1）临床医生建议在就诊前和就诊期间让患者准备好进行 SRH 对话；（2）需要咨询系统来促进与妇女健康提供者的快速 SRH 护理；（3）临床医生建议开发培训机会和易于获取的资源来解决 SRH 知识差距；（4）临床医生建议为患者提供有关风湿病学背景下 SRH 的教育材料。尽管 APP 和风湿病学家组之间产生了类似的想法，但风湿病学家通常对额外的培训和教育更感兴趣，而 APP 则对电子病历提示和工具更感兴趣。
提供者确定了许多增强风湿病学中 SRH 护理的潜在解决方案和促进因素，这些因素可能为干预措施的发展奠定基础。
