A mixed-methods study of barriers and facilitators to the implementation of postpartum hemorrhage guidelines in Uganda
A mixed-methods study of barriers and facilitators to the implementation of postpartum hemorrhage guidelines in Uganda
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DOI：
10.1016/j.ijgo.2015.06.047
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发表时间：
2016-01-01
影响因子：
3.8
通讯作者：
Stokes, Tim
中科院分区：
文献类型：
--
作者：
Braddick, Louise;Tuckey, Victoria;Stokes, Tim
目的：确定对产后出血临床指南建议的依从性水平，并探讨循证产科护理的特定背景障碍和促进因素。研究方法：在乌干达的一家医疗机构直接观察分娩情况，于2014年2月至3月进行了一项混合方法研究，以记录与第三产程（AMTSL）积极管理相关的实践。在何种程度上符合世界卫生组织产后出血指南的做法进行了测定。半结构化的采访进行了孕产妇保健医生。结果如下：在154名妇女中，分别有105名（68.2%）、119名（77.3%）和37名（61.7%）妇女发生了个体AMTSL，其形式为在第三产程期间给予子宫收缩剂、控制性脐带牵引或延迟脐带夹紧。然而，观察到接受所有三种AMTSL组分的53名个体中只有18名（34.0%）接受了AMTSL的所有基本要素。通过18次访谈确定了影响循证实践的三大主题：医疗系统问题;当前的知识，意识和临床指南的使用;以及医疗从业者对更新临床实践的态度。结论：总体指南依从性较低。有必要解决具体情况下的吸收障碍，确保准则得到执行，以降低低资源环境中的孕产妇死亡率。(C)2015年国际妇产科联合会。由Elsevier爱尔兰有限公司出版。保留所有权利。
Objective: To determine the level of adherence to postpartum hemorrhage clinical guideline recommendations and to explore context-specific barriers and facilitators to evidence-based obstetric care. Methods: Using direct observation of deliveries at a Ugandan healthcare facility, a mixed-methods study was conducted between February and March 2014 to document practices related to the active management of the third stage of labor (AMTSL). The degree to which practice concurred with WHO postpartum hemorrhage guidelines was determined. Semi-structured interviews were conducted with maternal healthcare practitioners. Results: Of 154 women, individual AMTSL, in the form of administering a uterotonic during the third stage of labor, controlled cord traction, or delayed cord clamping, occurred in 105 (68.2%), 119 (77.3%), and, of a subset of 60 patients, 37 (61.7%) individuals, respectively. However, only 18 of 53 (34.0%) individuals observed for receipt of all of the three AMTSL components received all of the essential elements of AMTSL. Three major themes influencing the uptake of evidence-based practice were identified through 18 interviews: healthcare system issues; current knowledge, awareness, and use of clinical guidelines; and healthcare practitioner attitudes to updating their clinical practice. Conclusion: Overall guideline adherence was low. There is a need to address context-specific barriers to uptake, ensuring guideline implementation to reduce maternal mortality in low-resource settings. (C) 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.