Simmelink Renate, Neppelenbroek Elise, Pouwels Anneke, van der Lee Nadine, Pajkrt Eva, Ziesemer Kirsten A, Harmsen van der Vliet-Torij Hanneke W, Verhoeven Corine J M, de Jonge Ank, Nieuwenhuijze Marianne
Midwifery Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
BMJ Open. 2025 Feb 20;15(2):e091968. doi: 10.1136/bmjopen-2024-091968.
To understand how and under what circumstances midwife-led continuity of care (MLCC) can be implemented in high-income countries.
A realist review was conducted to examine interactions between contexts, mechanisms and outcomes.
An initial programme theory described a hypothesis of how MLCC might be implemented successfully. Literature from a systematic search on the implementation of MLCC was synthesised and supplemented with unstructured searches to identify literature that reinforced the emerging concepts. The synthesis was an iterative process, endorsed in consultation with stakeholders, leading to a refined programme theory.
A total of 45 documents were included. The mechanisms identified can be grouped around macrolevel challenges, leadership, role ambiguity and conflict, and personal and professional boundaries. Despite strong evidence supporting MLCC, diverse stakeholder interests and power dynamics hinder its implementation. Implementing MLCC disrupts established roles and power structures, creating uncertainty and anxiety at all levels. To successfully navigate healthcare providers through the transition, both formal and informal leaders must demonstrate the courage and vision to challenge existing norms.
Realist methodology allowed the identification of mechanisms that often remain unnoticed but significantly impact the implementation of MLCC. Concrete policies and guidelines are essential to ensure consistency in care delivery. Collaborative efforts and a shared philosophy among all stakeholders, combined with strong leadership that builds trust and addresses anxiety, can create a supportive environment for MLCC implementation.
CRD42023446437.
了解在高收入国家如何以及在何种情况下实施由助产士主导的连续性护理（MLCC）。
进行了一项现实主义综述，以研究背景、机制和结果之间的相互作用。
一个初始的项目理论描述了MLCC可能成功实施的假设。对关于MLCC实施的系统检索文献进行了综合，并辅以非结构化检索，以识别强化新兴概念的文献。综合是一个迭代过程，经与利益相关者协商认可，形成了一个完善的项目理论。
共纳入45份文献。所确定的机制可围绕宏观层面的挑战、领导力、角色模糊与冲突以及个人和职业界限进行分组。尽管有强有力的证据支持MLCC，但不同利益相关者的利益和权力动态阻碍了其实施。实施MLCC会打乱既定的角色和权力结构，在各个层面造成不确定性和焦虑。为了在转型过程中成功引导医疗服务提供者，正式和非正式领导者都必须展现出挑战现有规范的勇气和远见。
现实主义方法能够识别那些常常未被注意但对MLCC实施有重大影响的机制。具体的政策和指南对于确保护理服务的一致性至关重要。所有利益相关者之间的协作努力和共同理念，再加上建立信任并解决焦虑的强有力领导，可为MLCC的实施创造一个支持性环境。
PROSPERO注册号：CRD42023446437。
