背景:合法化和引入后近30年,助产仍未在加拿大最大省份的卫生系统中得到最佳整合,安大略省。筹资模式已被确定为主要障碍之一。
方法:使用建构主义的观点,我们进行了一项定性的描述性研究,以检查产前,产时,安大略省的产后资金安排会影响助产一体化。我们将最佳的“整合”概念化为助产士知识的情况,技能,护理模式得到广泛尊重和充分利用,跨专业合作和转诊支持为患者提供最佳护理,助产士对医院和更大的卫生系统有归属感。我们通过半结构化电话采访助产士收集数据,产科医生,家庭医生,和护士。使用专题分析检查数据。
结果:我们采访了20名参与者,包括5名产科医生,5位家庭医生,5名助产士,4名护士,1名政策专家。我们发现,虽然基于护理课程的助产资金被认为支持高水平的助产服务客户满意度和出色的临床结果,缺乏灵活性。这限制了跨专业合作和助产士利用其知识和技能应对卫生系统差距的机会。医生按服务收费的资助模式为生育带来竞争,有意想不到的后果,限制助产士的范围和获得医院特权,未能适当补偿医生顾问,特别是随着助产量的增长。医院资助的助产士资助进一步限制了助产士对社区医疗保健需求的创新贡献。
结论:重大政策变化,例如顾问的足够报酬,可能包括以工资为基础的医生资金;在现有护理模式之外,灵活地补偿助产士的护理;以及需要一个明确规定的性和生殖护理卫生人力资源计划,以改善助产一体化。
BACKGROUND: Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada\'s largest province, Ontario. Funding models have been identified as one of the main barriers.
METHODS: Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal \'integration\' as circumstances in which midwives\' knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis.
RESULTS: We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives\' scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs.
CONCLUSIONS: Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.