The development and application of a new tool to assess the adequacy of the content and timing of antenatal care
The development and application of a new tool to assess the adequacy of the content and timing of antenatal care
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DOI：
10.1186/1472-6963-11-213
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发表时间：
2011-09-06
影响因子：
2.8
通讯作者：
Putman, Koen
中科院分区：
文献类型：
--
作者：
Beeckman, Katrien;Louckx, Fred;Putman, Koen
背景：目前的产前保健措施仅限于开始护理和就诊次数。本研究的目的是描述的开发和应用的工具，以评估产前保健的内容和时间的充分性。方法：内容和时间的护理在怀孕期间（CTP）的工具开发的基础上，临床相关性正在进行的产前保健和建议，在国家和国际准则。该工具反映了在每次怀孕中建议的最低限度护理，无论产次或风险状况如何。CTP测量开始护理的时间、护理内容（血压读数、血液检查和超声波扫描的数量）以及是否在适当的时间接受干预。然后使用标准工具（APNCU指数）描述了333名孕妇的产前护理轨迹，该工具仅测量护理数量，以及新的CTP工具。这两种工具都将护理分为4类，从“不充分”（两种工具）到“充分+”（APNCU）或“适当”（CTP）。参与者使用日记前瞻性地记录了产前护理的时间和内容。分析包括检查的相似性和差异之间的工具分类的护理episodes.Results：根据CTP工具，10，2%的妇女的护理轨迹被归类为不足，8，4%为中间，36%为足够和45，3%为适当的。护理质量的评估显着不同的两种工具。被APNCU归类为“充分”或“充分+”的17个护理轨迹被CTP视为“不充分”。这表明，尽管大量的访问，这些妇女没有收到最低限度的建议内容和时间的照顾。结论：CTP工具提供了一个更详细的评估产前保健的充分性比目前的标准指数。然而，关于产前保健内容的指导方针各不相同，该工具目前没有将过度使用干预措施列为“不适当”。在对新措施的影响进行更大规模的测试之前，需要做进一步的工作来完善内容项目。
Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care.Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from 'Inadequate' (both tools) to 'Adequate plus' (APNCU) or 'Appropriate' (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools.Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as 'Adequate' or 'Adequate plus' by the APNCU were deemed 'Inadequate' by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care.Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as 'Inappropriate'. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure.