Nesbitt T S, Davidson R C, Paliescheskey M, Fox-Garcia J, Arevalo J A
Department of Family Practice, University of California, Davis, Sacramento.
Fam Med. 1994 Mar;26(3):149-53.
Only 24% of family physicians in the United States deliver babies, a figure that declined remarkably during the decade of the 1980s. This study examines the content of practice, with regard to maternity care, of graduates of the University of California, Davis Family Practice Residency Network over the past 20 years, and the effectiveness of residency training intervention designed to increase maternity care activity among graduates.
Using a mailed survey instrument, graduates of the UC Davis Family Practice Residency Network have been periodically surveyed on practice characteristics since 1978. Using data from these surveys, maternity care and other practice characteristics of all graduates were analyzed using descriptive statistics. Data on trends in maternity care of two groups of residents who graduated a decade apart were evaluated. A separate evaluation of the two most recent graduating classes was performed to evaluate an intervention at the Network's university-based program. The program had been designed to increase the number of graduates who provide maternity care.
Survey responses from previous graduates of the six network programs showed that only 31% included maternity care in their practices at the time of the 1991 survey. Sixty-one percent of a cohort of graduates from a 3-year period from 1979 through 1981 included maternity care upon entering practice. The 3-year cohort of residents graduating a decade later, during the years 1988-1990, had an initial participation rate in maternity care of only 37% in 1991. However, only 11% of the graduates from the university-based program in the 1988-1990 cohort made an initial decision to include maternity care in their practice. For the graduates of this program from 1991 and 1992, a period following the specific intervention, participation in maternity care increased to 50%.
This study documents the decrease in interest in providing obstetrical services by recent family practice residency graduates when compared to graduates a decade earlier. Further, it suggests that residency programs, even with very low rates of participation in maternity care, can increase the interest and participation of residents to include these services in their practices after graduation.
在美国，仅有24%的家庭医生接生婴儿，这一数字在20世纪80年代十年间显著下降。本研究调查了加利福尼亚大学戴维斯分校家庭医学住院医师培训网络在过去20年中的毕业生在产科护理方面的实践内容，以及旨在增加毕业生产科护理活动的住院医师培训干预措施的有效性。
自1978年以来，使用邮寄调查问卷对加利福尼亚大学戴维斯分校家庭医学住院医师培训网络的毕业生定期进行实践特征调查。利用这些调查数据，采用描述性统计分析所有毕业生的产科护理及其他实践特征。评估了毕业时间相隔十年的两组住院医师在产科护理方面的趋势数据。对最近的两个毕业班进行了单独评估，以评价该网络在大学项目中的一项干预措施。该项目旨在增加提供产科护理的毕业生人数。
对六个网络项目往届毕业生的调查回复显示，在1991年的调查中，只有31%的毕业生在其业务中提供产科护理。1979年至1981年这三年期间毕业的一批毕业生中，61%在开始执业时提供产科护理。十年后的1988 - 1990年毕业的三年住院医师群体，1991年产科护理的初始参与率仅为37%。然而，1988 - 1990年群体中来自大学项目的毕业生只有11%最初决定在其业务中提供产科护理。对于1991年和1992年该项目的毕业生，在特定干预措施实施后的一段时间内，产科护理的参与率增加到了50%。
本研究表明，与十年前的毕业生相比，近期家庭医学住院医师培训毕业生对提供产科服务的兴趣有所下降。此外，这表明住院医师培训项目即使在产科护理参与率非常低的情况下，也能提高住院医师在毕业后将这些服务纳入其业务的兴趣和参与度。
