School of Nursing, Curtin University, Bentley, Western Australia, Australia.
Medical School, University of Western Australia, Albany, Western Australia, Australia.
PLoS One. 2024 May 21;19(5):e0296537. doi: 10.1371/journal.pone.0296537. eCollection 2024.
In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women's decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care.
This study used a qualitative descriptive approach. General practitioners (N = 12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data.
Two broad themes were interpreted from the data. The first theme entitled 'GP Factors', incorporated three associated sub-themes including '1) GPs Previous Model of Care Experience', '2) Gaps in GP Knowledge' and '3) GP Perception of Models of Care'. The second theme, entitled 'Woman's Factors', encapsulated two associated sub-themes including the '4) Woman's Preferences' and '5) Access to Models'.
This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. Predominant findings suggest that gaps in GP knowledge regarding the available models of care are present and are largely informed by prior personal and professional experience. Most GPs described referring to models of care they perceive positively and centring their model of care discussions on the woman's preferences and accessibility. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this.
在澳大利亚的产科体系中，全科医生在为准父母提供产科护理模式建议和指导方面发挥着至关重要的作用。优化护理模式的讨论和决策过程可以避免产妇过度或不足的专科护理，减少护理转换的潜在破坏性，并降低不必要的医疗保健成本，这对于确保消费者的满意度至关重要。目前的文献主要集中在女性对护理模式讨论的决策上，而忽略了全科医生（GP）的把关作用。本研究旨在探讨和描述影响澳大利亚全科医生在为孕妇选择产科护理模式时的决策因素。
本研究采用定性描述方法。参与过澳大利亚将孕妇转诊至产科护理模式的全科医生（N=12）参与了半结构式访谈。访谈于 2021 年 10 月至 11 月期间通过电话或视频会议进行。使用 NVivo-12 数据管理软件对反思性主题分析进行辅助，对数据进行编码和解释主题。
从数据中解读出两个广泛的主题。第一个主题为“GP 因素”，包含三个相关的子主题，包括“1）GP 之前的护理模式经验”、“2）GP 知识差距”和“3）GP 对护理模式的看法”。第二个主题为“妇女因素”，包含两个相关的子主题，包括“4）妇女的偏好”和“5）获得护理模式的途径”。
本研究提供了关于全科医生对影响护理模式决策和转诊的因素的观点的新证据。主要发现表明，GP 对现有护理模式的知识存在差距，并且主要是由个人和专业经验所决定的。大多数 GP 描述了他们倾向于推荐他们认为积极的护理模式，并以妇女的偏好和可及性为中心进行护理模式讨论。对影响护理模式决策的因素的探讨和描述提供了独特的见解，了解了所有利益相关者如何能够获得更广泛的护理模式，包括与消费者需求一致的助产士主导的连续性护理模式。此外，还概述了国家初级卫生网络的作用，以实现这一目标。
