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接受护理的障碍:了解为什么产科患者违背医疗建议离开
Connie F Lu1, Chloe N Matovina2, Ashish Premkumar3
1Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St, Suite 03-2303, Chicago, IL, 60611, USA. connie.lu@nm.org.
产科患者违背医疗建议离开 (AMA) 面临系统性障碍,而不仅仅是个人选择. 解决外部和内在障碍可以改善母亲和婴儿的健康结果.
科学领域:
- 产科和妇科 产科和妇科
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在产科中,违背医疗建议 (AMA) 的出院未得到充分研究,并对边缘化人口产生不成比例的影响.
- AMA排放与不良围产期结果有关,但原因尚不清楚.
- 了解患者障碍对于改善护理和减少差异至关重要.
研究的目的:
- 识别阻碍产科患者接受推护理的障碍.
- 突出导致产科AMA出院的结构性原因.
- 为减少AMA排放和改善围产期健康的战略提供信息.
主要方法:
- 临床医生和社会工作者进展记录的定性主题分析.
- 对产科患者的电子健康记录的审查 退院AMA (2008-2018).
- 关于核准的记录理由的分类.
主要成果:
- 57名妇产科患者 (0.12%) 获得了AMA.
- 外在障碍 (照顾孩子,家庭职责) 是50.9%的患者提到的.
- 40.4%的患者引用了内在障碍 (分歧,痛苦,不信任,物质使用).
- 在19.3%的AMA排放中,没有证据表明原因.
结论:
- 术语AMA不公平地指责患者,掩盖系统障碍.
- 产科患者面临着外在和内在的障碍,导致AMA出院.
- 解决结构性障碍和与患者合作,可以防止AMA出院,改善母婴健康和生殖正义.
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