产科医生应该诊治正常妊娠的女性吗？一项多中心随机对照试验，比较了全科医生和助产士进行的常规产前护理与产科医生主导的共同护理。
Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.
作者信息
Tucker J S, Hall M H, Howie P W, Reid M E, Barbour R S, Florey C D, McIlwaine G M
机构信息
Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School.
出版信息
BMJ. 1996 Mar 2;312(7030):554-9. doi: 10.1136/bmj.312.7030.554.
OBJECTIVE
To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care.
DESIGN
Multicentre randomised controlled trial.
SETTING
51 general practices linked to nine Scottish maternity hospitals.
SUBJECTS
1765 women at low risk of antenatal complications.
INTERVENTION
Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications.
MAIN OUTCOME MEASURES
Comparisons of health service use, indicators of quality of care, and women's satisfaction.
RESULTS
Continuity of care was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6).
CONCLUSION
Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.
目的
比较全科医生和助产士提供的常规产前护理与产科医生主导的共享护理。
设计
多中心随机对照试验。
设置
与九家苏格兰 maternity 医院相关联的 51 家全科诊所。
研究对象
1765 名产前并发症低风险的女性。
干预措施
全科医生和助产士根据护理计划和并发症管理方案提供常规产前护理。
主要观察指标
卫生服务利用情况、护理质量指标和女性满意度的比较。
结果
全科医生和助产士组的护理连续性得到改善，因为护理人员数量较少（中位数为 5 名护理人员，而共享护理组为 7 名，P<0.0001），常规就诊次数减少（10.9 次对 11.7 次，P<0.0001）。全科医生和助产士组中进行产前入院的女性较少（27%（222/834）对 32%（266/840），P<0.05），未就诊的较少（7%（57 例）对 11%（89 例），P<0.01），日间护理的较少（12%（102 例）对 7%（139 例），P<0.05），但转诊的较多（49%（406 例）对 36%（305 例），P<0.0001）。除了全科医生和助产士组中患有高血压疾病（妊娠高血压，5%（37 例）对 8%（70 例），P<0.01）和引产的女性较少（18%（149 例）对 24%（201 例），P<0.01）外，产前诊断率没有差异。很少出现不遵守护理方案的情况，但全科医生和助产士组中更多的 Rh 阴性女性没有进行适当的抗体检查（2.5%（20 例）对 0.4%（3 例），P<0.0001）。两组对护理都表示高度满意（68%（453/663）对 65%（430/656），P = 0.5），对分配的护理方式的可接受性也相似（93%（618 例）对 94%（624 例），P = 0.6）。分娩前获得医院支持的情况相似（45%（302 例）对 48%（312 例）在分娩前访问过产房，P = 0.6）。
结论
对于最初妊娠并发症风险较低的女性进行常规专科就诊几乎没有临床或消费者益处。
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