Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver
Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver
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DOI：
10.2105/ajph.2012.301159
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发表时间：
2013-03-01
影响因子：
12.7
通讯作者：
Drey, Eleanor A.
中科院分区：
文献类型：
--
作者：
Weitz, Tracy A.;Taylor, Diana;Drey, Eleanor A.
目标.我们研究了对患者安全的影响，如果执业护士（NPs），注册护士助产士（CNMs），和医生助理（PA）被允许提供在加利福尼亚州的吸入性流产。在一项前瞻性、观察性研究中，我们采用非劣效性设计（预先确定的可接受风险差异为2%），评价了由4家计划生育联合会附属机构和北方加州Kaiser Permanente的医生（n = 5812）和新培训的NP、CNM和PA（n = 5675）完成的11487例早期吸入性流产的结局。包括流产后4周内的所有并发症。在分析的11487例吸入性流产中，1.3%（n = 152）导致并发症：NP-、CNM-和PA-进行的抽吸为1.8%，医生进行的抽吸为0.9%。NP-CNM-PA组和医生组之间总并发症的未校正风险差异为0.87（95%置信区间[CI] = 0.45，1.29），在倾向评分匹配的样本中为0.83（95% CI = 0.33，1.33）。堕胎并发症在新培训的NPs，CNMs和PA和医生之间具有临床等效性，支持通过政策，允许这些提供者执行早期愿望，以扩大获得堕胎护理的机会。
Objectives. We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California.Methods. In a prospective, observational study, we evaluated the outcomes of 11 487 early aspiration abortions completed by physicians (n = 5812) and newly trained NPs, CNMs, and PAs (n = 5675) from 4 Planned Parenthood affiliates and Kaiser Permanente of Northern California, by using a noninferiority design with a predetermined acceptable risk difference of 2%. All complications up to 4 weeks after the abortion were included.Results. Of the 11 487 aspiration abortions analyzed, 1.3% (n = 152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between NP-CNM-PA and physician groups was 0.87 (95% confidence interval [CI] = 0.45, 1.29) and 0.83 (95% CI = 0.33, 1.33) in a propensity score-matched sample.Conclusions. Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform-early aspirations to expand access to abortion care.