评估堕胎后护理任务共享的研究主要集中在妊娠早期的妇女,许多研究缺乏定性成分。我们旨在与医生相比,评估使用助产士提供的米索前列醇治疗不完全妊娠中期流产的患者可接受性,并对乌干达患者的生活治疗经验有了更深入的了解。
我们的混合方法研究结合了来自随机对照等效试验的1140个结构化访谈数据,以及在乌干达14个公共卫生机构接受米索前列醇治疗的中期妊娠不完全流产妇女的深度访谈(n=28)。可接受性,我们的主要结果,在14天的随访中使用结构化问卷作为复合变量进行测量:1)治疗经验(如预期/好于预期/差于预期),和2)满意度-如果患者会向朋友推荐治疗或再次选择方法。我们使用广义混合效应模型来获得助产士和医生组之间可接受的流产后护理的风险差异。我们对定性数据采用归纳内容分析。
从2018年8月14日至2021年11月16日,我们评估了7190名妇女的资格,并随机分配了1191名妇女(593名助产士和598名医生)。我们成功随访了1140名妇女和1071名(94%),发现治疗可接受。两组之间调整后的风险差异为1.2%(95%CI,-1.2至3.6%),并且在我们预定义的-5至+5%的等效范围内。治疗成功,治疗后感到平静和安全提高了可接受性,而副作用和令人担忧的出血模式的经验降低了满意度。
与医生相比,由助产士提供护理时,米索前列醇治疗无并发症的妊娠中期不完全流产的妇女同样且高度可接受。在缺乏足够的医生人员配备水平或助产士可以提供米索前列醇的环境中,与助产士共享孕中期医疗PAC的任务增加了患者获得堕胎后护理服务的机会。
ClinicalTrials.govNCT03622073。
大约9.6%的堕胎相关死亡发生在撒哈拉以南非洲。如果避免意外怀孕,这些死亡是可以预防的,妇女可以在国家法律的期望范围内获得安全堕胎,并公平提供堕胎后护理(PAC)服务。先前的研究表明,在怀孕的头三个月有流产并发症的妇女可以由助产士或医生用米索前列醇治疗。助产士和医生之间的任务共享是安全的,有效,并且可以接受。然而,妊娠中期任务分担的证据存在差距。检查中孕期任务分担的实用性,我们的目的是评估患者接受由助产士提供的米索前列醇治疗不完全妊娠中期流产的可接受性,并对患者的生活治疗经验有了更深入的了解。因此,我们的研究结合了定量和定性方法。与医生相比,由助产士提供的米索前列醇治疗妊娠中期不完全流产的妇女可接受性同样可接受。治疗成功,治疗后感到平静和安全,增加了可接受性,而副作用和令人担忧的出血模式的经验降低了满意度。为妇女提供咨询可以解决其中一些问题,因为它提供了保证并减少了焦虑。在缺乏足够的医生人员配备水平或助产士可以提供米索前列醇的环境中,与助产士共享孕中期医疗PAC的任务增加了患者对PAC服务的访问。
Studies evaluating task sharing in postabortion care have mainly focused on women in first trimester and many lack a qualitative component. We aimed to evaluate patient acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians and also gained a deeper understanding of the patients\' lived treatment experiences in Uganda.
Our mixed methods
study combined 1140 structured interview data from a randomized controlled equivalence
trial and in-depth interviews (n = 28) among women managed with misoprostol for second trimester incomplete abortion at 14 public health facilities in Uganda. Acceptability, our main outcome, was measured at the 14-day follow-up visit using a structured questionnaire as a composite variable of: 1) treatment experience (as expected/ better than expected/ worse than expected), and 2) satisfaction - if patient would recommend the treatment to a friend or choose the method again. We used generalized mixed effects models to obtain the risk difference in acceptable post abortion care between midwife and physician groups. We used inductive content analysis for qualitative data.
From 14th August 2018 to 16th November 2021, we assessed 7190 women for eligibility and randomized 1191 (593 to midwife and 598 to physician). We successfully followed up 1140 women and 1071 (94%) found the treatment acceptable. The adjusted risk difference was 1.2% (95% CI, - 1.2 to 3.6%) between the two groups, and within our predefined equivalence range of - 5 to + 5%. Treatment success and feeling calm and safe after treatment enhanced acceptability while experience of side effects and worrying bleeding patterns reduced satisfaction.
Misoprostol treatment of uncomplicated second trimester incomplete abortion was equally and highly acceptable to women when care was provided by midwives compared with physicians. In settings that lack adequate staffing levels of physicians or where midwives are available to provide misoprostol, task sharing second trimester medical PAC with midwives increases patient\'s access to postabortion care services.
ClinicalTrials.gov NCT03622073.
Approximately 9.6% of abortion-related deaths occur in Sub-Saharan Africa. These deaths can be prevented if unintended pregnancies are avoided, women can access safe abortions within the expectations of the country’s laws, and post abortion care (PAC) services are provided equitably. Previous research shows that women with abortion complications in the first trimester of pregnancy can be treated with misoprostol by either midwives or physicians. This sharing of tasks between the midwives and physicians is safe, effective, and acceptable. However, there is a gap in evidence on task sharing in the second trimester. To check practicability of task sharing in second trimester, we aimed to evaluate patient acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians and also gained a deeper understanding of the patients’ lived treatment experiences. Our
study therefore combined quantitative and qualitative approaches. Women’s acceptability of misoprostol treatment for incomplete second trimester abortion was found to be equally acceptable when provided by midwives compared with physicians. Treatment success, feeling calm and safe after treatment increased acceptability, while experience of side effects and worrying bleeding patterns reduced satisfaction. Counselling of women may address some of these problems since it provides reassurance and reduces anxiety. In settings that lack adequate staffing levels of physicians or where midwives are available to provide misoprostol, task sharing second trimester medical PAC with midwives increases patient’s access to PAC services.