Patient Preferences for Prenatal and Postpartum Care Delivery A Survey of Postpartum Women
Patient Preferences for Prenatal and Postpartum Care Delivery A Survey of Postpartum Women
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DOI：
10.1097/aog.0000000000003731
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发表时间：
2020-05-01
影响因子：
7.2
通讯作者：
Smith, Roger D.
中科院分区：
文献类型：
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作者：
Peahl, Alex Friedman;Novara, Alli;Smith, Roger D.
目的：描述患者对产前和产后护理的偏好。方法：我们进行了一项横断面调查的产后病人入院分娩和恢复在一个学术机构。我们评估了患者对产前和产后护理的偏好，包括访视次数、访视间联系方式（例如，电话和电子病历门户通信）、远程监测的可接受性（例如，体重、血压、胎心音）和替代护理模式（例如，远程医疗和家访）。我们将产前检查次数的偏好与目前美国妇产科医师学会的建议（12-14次产前检查）进行了比较。结果：在符合研究条件的332名妇女中，300名（90%）完成了调查。妇女希望产前检查的中位数为10次（四分位数范围9-12），大多数妇女希望比目前推荐的次数少（少于12：63% [n=189]; 12-14：22% [n=65];超过14：15% [n=46]）。有私人保险的妇女或白色妇女更倾向于减少产前检查。大多数患者希望在访视之间与他们的护理团队联系（84%）。大多数患者报告了家庭监测技能的舒适度，包括测量体重（91%），血压（82%）和胎心音（68%）。患者报告说，他们最有可能使用个人护理模式（94%），其次是怀孕医疗之家（72%）和家访（69%）。大多数患者希望至少两次产后访视（91%），首次访视在出院后3周内（81%）。结论：目前的产前和产后护理服务不符合患者对就诊次数或两次就诊之间联系的偏好，患者愿意接受产前护理的替代模式，包括远程监测。未来的产前护理重新设计将需要考虑不同的患者的偏好和灵活的护理模式，这些模式适合在患者的生活和社区背景下与患者合作。
OBJECTIVE: To describe patients' preferences for prenatal and postpartum care delivery. METHODS: We conducted a cross-sectional survey of postpartum patients admitted for childbirth and recovery at an academic institution. We assessed patient preferences for prenatal and postpartum care delivery, including visit number, between-visit contact (eg, phone and electronic medical record portal communication), acceptability of remote monitoring (eg, weight, blood pressure, fetal heart tones), and alternative care models (eg, telemedicine and home visits). We compared preferences for prenatal care visit number to current American College of Obstetricians and Gynecologists' recommendations (12-14 prenatal visits). RESULTS: Of the 332 women eligible for the study, 300 (90%) completed the survey. Women desired a median number of 10 prenatal visits (interquartile range 9-12), with most desiring fewer visits than currently recommended (fewer than 12: 63% [n=189]; 12-14: 22% [n=65]; more than 14: 15% [n=46]). Women who had private insurance or were white were more likely to prefer fewer prenatal visits. The majority of patients desired contact with their care team between visits (84%). Most patients reported comfort with home monitoring skills, including measuring weight (91%), blood pressure (82%), and fetal heart tones (68%). Patients reported that they would be most likely to use individual care models (94%), followed by pregnancy medical homes (72%) and home visits (69%). The majority of patients desired at least two postpartum visits (91%), with the first visit within 3 weeks after discharge (81%). CONCLUSION: Current prenatal and postpartum care delivery does not match patients' preferences for visit number or between-visit contact, and patients are open to alternative models of prenatal care, including remote monitoring. Future prenatal care redesign will need to consider diverse patients' preferences and flexible models of care that are tailored to work with patients in the context of their lives and communities.