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中立提供还是强烈推荐?挪威国家指南指导下的全科医生对妊娠期糖尿病筛查的观点。

To neutrally offer or strongly recommend? General practitioners' perspectives on screening for gestational diabetes according to the national guideline in Norway.

机构信息

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.

出版信息

Scand J Prim Health Care. 2024 Dec;42(4):668-676. doi: 10.1080/02813432.2024.2378204. Epub 2024 Jul 15.

Abstract

OBJECTIVE

To explore general practitioners' experiences and reflections on how the current Norwegian guideline for screening for gestational diabetes affects their clinical practice.

DESIGN

A qualitive study in which data were collected through semi-structured focus group interviews and analyzed thematically.

SETTING AND SUBJECTS

Five focus groups conducted in 2020 among GPs in Norway; three interviews took place face-to-face and two were held digitally. The total number of participants was 31.

RESULTS

GPs acknowledged the potential benefits of more extensive screening, but had concerns about the medicalization of pregnancy, stating that some women experienced considerable anxiety. The GPs expressed doubts about the guideline's evidence base but differed in how they interpreted what the guideline was asking them to do. Some offered eligible women the opportunity to be screened, while other set up a screening appointment without consulting the women first. For some, fear of incrimination made them recommend screening without being convinced that it was the right thing for the patient.

CONCLUSIONS

It is unclear whether the guideline for gestational diabetes requires GPs to recommend screening to pregnant women or if they should provide neutral information about the availability of screening. This ambiguity should be addressed, and the guideline evaluated against the core principles of general practice.

摘要

目的

探讨全科医生对当前挪威妊娠期糖尿病筛查指南如何影响其临床实践的经验和反思。

设计

这是一项定性研究,通过半结构化焦点小组访谈收集数据,并进行主题分析。

地点和对象

2020 年在挪威进行的五组全科医生焦点小组;三次面访,两次线上。参与者总数为 31 人。

结果

全科医生承认更广泛筛查的潜在益处,但对妊娠的医学化表示担忧,称一些女性感到相当焦虑。全科医生对指南的证据基础表示怀疑,但对指南要求他们做什么的解释存在分歧。一些人向符合条件的女性提供筛查机会,而另一些人则在没有与女性协商的情况下安排了筛查预约。对于一些人来说,担心被指责使得他们在没有确信这对患者是正确的情况下建议进行筛查。

结论

目前尚不清楚该妊娠期糖尿病指南是否要求全科医生向孕妇推荐筛查,还是他们应该提供有关筛查可用性的中立信息。应该解决这种模糊性,并根据全科医学的核心原则对该指南进行评估。

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Dietary guidance from GPs - what do patients report?全科医生的饮食指导——患者有何反馈?
Tidsskr Nor Laegeforen. 2024 Mar 18;144(4). doi: 10.4045/tidsskr.23.0447. Print 2024 Mar 19.
2
Prevalence and treatment of gestational diabetes in Norway 2010-2020.2010 - 2020年挪威妊娠期糖尿病的患病率及治疗情况
Diabetes Res Clin Pract. 2024 Jan;207:111025. doi: 10.1016/j.diabres.2023.111025. Epub 2023 Nov 22.
3
4
Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy.早孕期诊断的妊娠期糖尿病的治疗。
N Engl J Med. 2023 Jun 8;388(23):2132-2144. doi: 10.1056/NEJMoa2214956. Epub 2023 May 5.

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