Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
Department of Reproductive Medicine and Infertility, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda.
BMC Womens Health. 2022 Nov 5;22(1):434. doi: 10.1186/s12905-022-02027-y.
Studies evaluating task sharing in postabortion care have mainly focused on women in first trimester and many lack a qualitative component. We aimed to evaluate patient acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians and also gained a deeper understanding of the patients' lived treatment experiences in Uganda.
Our mixed methods study combined 1140 structured interview data from a randomized controlled equivalence trial and in-depth interviews (n = 28) among women managed with misoprostol for second trimester incomplete abortion at 14 public health facilities in Uganda. Acceptability, our main outcome, was measured at the 14-day follow-up visit using a structured questionnaire as a composite variable of: 1) treatment experience (as expected/ better than expected/ worse than expected), and 2) satisfaction - if patient would recommend the treatment to a friend or choose the method again. We used generalized mixed effects models to obtain the risk difference in acceptable post abortion care between midwife and physician groups. We used inductive content analysis for qualitative data.
From 14th August 2018 to 16th November 2021, we assessed 7190 women for eligibility and randomized 1191 (593 to midwife and 598 to physician). We successfully followed up 1140 women and 1071 (94%) found the treatment acceptable. The adjusted risk difference was 1.2% (95% CI, - 1.2 to 3.6%) between the two groups, and within our predefined equivalence range of - 5 to + 5%. Treatment success and feeling calm and safe after treatment enhanced acceptability while experience of side effects and worrying bleeding patterns reduced satisfaction.
Misoprostol treatment of uncomplicated second trimester incomplete abortion was equally and highly acceptable to women when care was provided by midwives compared with physicians. In settings that lack adequate staffing levels of physicians or where midwives are available to provide misoprostol, task sharing second trimester medical PAC with midwives increases patient's access to postabortion care services.
ClinicalTrials.gov NCT03622073.
评估流产后护理任务分担的研究主要集中在孕早期的妇女身上，而且许多研究缺乏定性部分。我们旨在评估助产士提供米索前列醇治疗不完全性中期妊娠流产的患者接受程度，与医生进行比较，并深入了解乌干达患者的实际治疗体验。
我们的混合方法研究结合了一项随机对照等效试验的 1140 份结构访谈数据和 28 名在乌干达 14 个公共卫生机构接受米索前列醇治疗不完全性中期妊娠流产的妇女的深入访谈。可接受性是我们的主要结局，在第 14 天的随访中使用结构问卷作为复合变量进行衡量：1）治疗体验（如预期/好于预期/差于预期）和 2）满意度-如果患者会向朋友推荐该治疗方法或再次选择该方法。我们使用广义混合效应模型来获得助产士和医生组之间可接受的流产后护理的风险差异。我们使用归纳内容分析方法对定性数据进行分析。
从 2018 年 8 月 14 日至 2021 年 11 月 16 日，我们评估了 7190 名妇女的资格，并随机分配了 1191 名（593 名给助产士，598 名给医生）。我们成功随访了 1140 名妇女，其中 1071 名（94%）认为治疗是可接受的。两组之间的调整风险差异为 1.2%（95%CI，-1.2 至 3.6%），在我们定义的-5 至+5%的等效范围内。治疗成功和治疗后感到平静和安全增强了可接受性，而副作用的体验和担心的出血模式降低了满意度。
当由助产士而不是医生提供米索前列醇治疗未合并的中期妊娠不完全流产时，该方法对妇女来说同样是可接受的。在缺乏足够的医生人手或有能力提供米索前列醇的助产士的情况下，与医生相比，将中期妊娠的医疗 PAC 任务分担给助产士可以增加患者获得流产后护理服务的机会。
ClinicalTrials.gov NCT03622073。
