Aved B M, Irwin M M, Cummings L S, Findeisen N
Sierra Health Foundation, Rancho Cordova.
West J Med. 1993 May;158(5):493-8.
Inadequate prenatal care is associated with poor birth outcomes. Recognizing barriers to care is necessary to improve results. Postpartum in-hospital interviews were conducted with women admitted through emergency departments with no physician of record (n = 69) in 8 Sacramento hospitals during April and May 1991. A focus group of local obstetrician-gynecologists was used to determine physicians' attitudes about caring for low-income women. We undertook the study in response to an increased number of "no doc" births. The inability to find a physician willing to accept them was reported by the women as the single largest barrier to obtaining care, cited by 64% of women overall and 96% of those who tried but were unable to obtain care. Transportation difficulties were a problem regardless of women's success in obtaining care and were ranked as the top barrier by women who never tried to obtain care. Physicians cited administrative difficulties and reimbursement levels of Medi-Cal plus extra care requirements and resource dependency of low-income patients as barriers to caring for this population. The value ascribed to prenatal care by women and physicians' perceptions of women's attitudes about care contrasted sharply. The link between poor women and physicians providing obstetric services can be fragile. The difficulty finding physicians willing to take them indicates that these women need special support services to ensure adequate care during pregnancy.
产前护理不足与不良分娩结局相关。认识到护理障碍对于改善结果很有必要。1991年4月和5月期间，在萨克拉门托的8家医院对通过急诊科入院且无备案医生的女性（n = 69）进行了产后住院访谈。利用当地妇产科医生焦点小组来确定医生对照顾低收入女性的态度。我们开展这项研究是因为“无医生”分娩数量增加。女性报告称，找不到愿意接收她们的医生是获得护理的最大障碍，总体上64%的女性以及96%尝试但未能获得护理的女性提到了这一点。无论女性在获得护理方面是否成功，交通困难都是一个问题，从未尝试获得护理的女性将其列为首要障碍。医生提到行政困难、医疗补助的报销水平加上额外护理要求以及低收入患者对资源的依赖是照顾这一人群的障碍。女性对产前护理的重视程度与医生对女性护理态度的看法形成鲜明对比。贫困女性与提供产科服务的医生之间的联系可能很脆弱。难以找到愿意接收她们的医生表明，这些女性需要特殊的支持服务来确保孕期获得充分护理。
