Feasibility and Acceptability of Screening for Adverse Childhood Experiences in Prenatal Care
Feasibility and Acceptability of Screening for Adverse Childhood Experiences in Prenatal Care
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DOI：
10.1089/jwh.2017.6649
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发表时间：
2018-01-19
影响因子：
3.5
通讯作者：
Young-Wolff, Kelly C.
中科院分区：
文献类型：
--
作者：
Flanagan, Tracy;Alabaster, Amy;Young-Wolff, Kelly C.
前言：不良童年经历(ACE)在孕妇中很常见，并增加了围产期不良结局的风险，但很少有临床医生对产前患者进行ACE筛查。本研究的目的是评估在标准产前护理中筛查ACEs的可行性和可接受性。方法：我们评估了在两个Kaiser Permanente北加州医疗中心(N=480)进行的为期4个月的试点(2016年3月至2016年6月)，以筛查怀孕约14-23周的孕妇的ACE和弹性。我们通过电话调查检查了筛查的可接受性(N=210)，通过调查和焦点小组检查了临床医生(N=26)。结果：大多数符合条件的患者(78%)通过了筛查。接受筛查的患者中，非西班牙裔白人、亚洲人或其他或未知种族/民族的可能性明显高于非裔美国人或西班牙裔种族/民族(p=0.02)。在被筛选的人中，88%的人完成了问卷调查；54%的人报告了0个A，28%的人报告了1-2个A，18%的人报告了3个A。大多数患者在某种程度上或非常满意地完成问卷(91%)并与临床医生讨论ACE(93%)，并且强烈或有点强烈地同意临床医生应该询问他们的产前患者关于ACE的情况(85%)。临床医生报告说，试点前后在讨论A级、提供教育和提供资源(PS)方面的舒适度显著增加
Introduction: Adverse childhood experiences (ACEs) are common among pregnant women and contribute to increased risk for negative perinatal outcomes, yet few clinicians screen prenatal patients for ACEs. The purpose of this study was to evaluate the feasibility and acceptability of screening for ACEs in standard prenatal care. Methods: We evaluated a 4-month pilot (March 2016-June 2016) to screen pregnant women (at approximate to 14-23 weeks of gestation) for ACEs and resiliency in two Kaiser Permanente Northern California medical centers (N=480). We examined the acceptability of the screening to patients through telephone surveys (N=210) and to clinicians through surveys and focus groups (N=26). Results: Most eligible patients (78%) were screened. Patients who received the screening were significantly more likely to be non-Hispanic White, Asian, or of Other or Unknown race/ethnicity than African American or Hispanic race/ethnicity (p=0.02). Among those screened, 88% completed the questionnaires; 54% reported 0 ACEs, 28% reported 1-2 ACEs, and 18% reported 3 ACEs. Most patients were somewhat or very comfortable completing the questionnaires (91%) and discussing ACEs with their clinician (93%), and strongly or somewhat strongly agreed that clinicians should ask their prenatal patients about ACEs (85%). Clinicians reported significant pre- to postpilot increases in comfort discussing ACEs, providing education, and offering resources (ps