Yankowitz J, Howser D M, Ely J W
Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, USA.
Am J Obstet Gynecol. 1996 Apr;174(4):1361-5. doi: 10.1016/s0002-9378(96)70685-3.
Our purpose was to compare the use of the Iowa Expanded Serum Screening program (maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) by obstetricians and family physicians.
A registry was used to identify all obstetricians (160) and family physicians (404) who practice obstetrics in Iowa. A questionnaire exploring attitudes and practice patterns related to serum screening was mailed to these physicians.
The response rate was 80.3% overall. There were significant differences in the offering of serum screening (p < 0.001) for following three responses: obstetricians were more likely to offer screening through the Iowa Expanded Serum Screening Program than were family physicians (89.3% vs 57.2%) and less likely to offer screening outside the state program (9.9% vs 39.0%), whereas family physicians were more likely to not offer screening (0.8% vs 3.8%). When the responses of the physicians who offer screening were analyzed, several differences emerged: (1) obstetricians were more likely than family physicians to offer screening to all obstetric patients (99.2% vs 92.1%, p < 0.05), whereas family physicians were more likely to offer testing to patients with perceived risks for neural tube defects or chromosomal abnormalities and to those patients who requested it, (2) obstetricians were more likely to recommend screening than family physicians (39.0% vs 25.7%, p < 0.05), who more often discouraged testing, although the latter did not reach statistical significance, (3) family physicians more than obstetricians felt that screening was not necessary if the patient would not terminate the pregnancy for neural tube defects (41.6% vs 19.1%, p < 0.001) or chromosomal abnormalities (39.7% vs 21.4%, p < 0.01), and (4) obstetricians used nurses to counsel patients to a much greater extent than family physicians did (44.6% vs 14.0%, p < 0.001).
There is a significant difference in practice patterns between obstetricians and family physicians in their reported use and presentation of maternal serum screening. Guidelines based on outcome studies should be developed and followed by obstetricians and family physicians.
我们的目的是比较产科医生和家庭医生对爱荷华州扩大血清筛查项目（母体血清甲胎蛋白、人绒毛膜促性腺激素和非结合雌三醇）的使用情况。
利用一个登记处来确定在爱荷华州从事产科工作的所有产科医生（160名）和家庭医生（404名）。向这些医生邮寄了一份调查问卷，以探究与血清筛查相关的态度和实践模式。
总体回复率为80.3%。对于以下三种情况，血清筛查的提供情况存在显著差异（p<0.001）：产科医生比家庭医生更有可能通过爱荷华州扩大血清筛查项目提供筛查（89.3%对57.2%），而在州项目之外提供筛查的可能性较小（9.9%对39.0%），家庭医生则更有可能不提供筛查（0.8%对3.8%）。当对提供筛查的医生的回复进行分析时，出现了几个差异：（1）产科医生比家庭医生更有可能对所有产科患者提供筛查（99.2%对92.1%，p<0.05），而家庭医生更有可能对被认为有神经管缺陷或染色体异常风险的患者以及那些要求进行检测的患者进行检测；（2）产科医生比家庭医生更有可能推荐筛查（39.0%对25.7%，p<0.05），家庭医生则更常不鼓励检测，尽管后者未达到统计学显著性；（3）与产科医生相比，家庭医生更认为如果患者不会因神经管缺陷（41.6%对19.1%，p<0.001）或染色体异常（39.7%对21.4%，p<0.01）而终止妊娠，那么筛查就没有必要；（4）产科医生比家庭医生在更大程度上利用护士为患者提供咨询（44.6%对14.0%，p<0.001）。
产科医生和家庭医生在报告的母体血清筛查的使用和呈现方面的实践模式存在显著差异。基于结果研究的指南应该被制定出来，供产科医生和家庭医生遵循。
