كيفيت خدمات قبل از زايمان در مراكز بهداشتي ـ درماني وابسته به دانشگاه علوم پزشكي شهيد بهشتي

Assessment of quality of prenatal care in Shahid Beheshti University of Medical Sciences health centers

در اين مطالعه مقطعي، وضعيت ارايه خدمات مراقبتي در سه بعد ساختار، فرايندها و پيامد مورد ارزيابي قرار گرفت. روش نمونه گيري غيرتصادفي سهميه‌اي و تعداد نمونه 600 مورد مراقبت قبل از زايمان در 12كلينيك قبل از زايمان مراكز بهداشتي و درماني وابسته به دانشگاه علوم پزشكي شهيد بهشتي بود. ابزار جمع آوري اطلاعات شامل پرسشنامه و چك ليست مشاهده ساختار، چك ليست مشاهده فرايندهاي مراقبتي و پرسشنامه رضايتمندي مراجعان بود. در اين مطالعه 600 مورد ارايه مراقبت به مراجعان با ميانگين سن بارداري 9.42±29.32 هفته مورد بررسي قرار گرفت. ارزيابي در حيطه فرايندهاي مراقبتي نشان داد كه ميزان تطابق با وضعيت مطلوب در حيطه‌هاي: مشاوره قبل از زايمان 21.24± 55.49 درصد، تاريخچه گيري 11.35±48.71 درصد، علايم حياتي 10.55±53.41 درصد،‌ معاينات عمومي در مراجعان بار اول 13.23± 30.22 درصد، ‌معاينات مامايي 27.01±91.77 درصد،‌ آزمايشات خون 21.89±93.83 درصد،‌ آزمايش ادرار 26.29±86.85 درصد و سونوگرافي 4.3± 95.7 درصد بود. ميزان تطابق با وضعيت مطلوب در حيطه‌هاي آموزش سلامت فردي و آموزش علايم خطر نيز به ترتيب 17.10 ±6.54 و 27.09 ± 39.67 درصد بود. در حيطه ساختار ميزان تطابق امكانات در اتاق معاينه 10.29±98.33، در اتاق انتظار 18.96±79.16، شرايط فيزيكي 14.79± 94.44 و وسايل و تجهيزات 7.22± 90.55 و امكانات رسانه‌اي 12.68± 51.38 درصد بود. ارزيابي رضايتمندي مددجويان در حيطه پيامد خدمات نشان داد كه ميانگين ميزان رضايت مراجعان از ساختار خدمات 15.04±73.76 درصد و از ارايه مراقبت‌ها 13.13±70.54 درصد است. نتايج اين مطالعه نشان داد كه به رغم ارايه نسبتاً مطلوب معاينات مامايي و آزمايشات پاراكلينيك، ارايه ساير مراقبت‌ها و آموزش مشاوره داراي وضعيتي متوسط يا نامطلوب بود. مشاوره و آموزش يكي از اهداف مهم در ويزيت‌ها و مراقبت‌هاي دوران قبل از زايمان است كه نياز به برنامه ريزي و اجراي دقيق دارد. غربالگري خطرات رواني ـ اجتماعي و برنامه ريزي براي ارجاع مراجعان در معرض اين خطرات بايد مورد توجه قرار گيرد.

Objective: To evaluate the prenatal care status to improve quality of prenatal care services in Shahid Beheshti university hospital and health canters. Method: This was a cross sectional descriptive study to evaluate status of provided prenatal care services in three domain of structure of the services, procedures of care and outcomes. Using nonrandomized Quota sampling, 600 subjects of care were assessed in 12 prenatal clinics of hospital and health centers of the university. Tools of the study were included: a questionnaire and a checklist to observe facilities and equipment, a check list to observe the care procedure and a questionnaire to assess clients’ satisfaction. The tools were used to assess the percentages of conformity with desired situation. These tools were mainly provided by an instruction of ministry of health. Content and face validity of these tools were assessed by a team of reproductive health experts and concurrent inter-rater reliability of the checklists were demonstrated by correlation coefficient of 0.84. Reliability of the satisfaction questionnaire was also shown by correlation coefficient of 0.9 and 0.95 using half splitting and test-retest methods. Data was analyzed by SPSS version 16 and using descriptive statistics and student t test and using 95% confidence interval. Results: 600 subjects with average pregnancy duration of 29.32±9.42 weeks were assessed in the study. Assessment of different care procedures demonstrated the percentages of conformity with desired situation as follow: counseling procedures 55.49±21.24 percent, history-taking procedure 48.71±11.36 percent, vital signs assessment 53.41±10.55 percent, general examination for first time attended clients 30.22±13.23 percent, obstetrical examination 91.77±27.01 percent, blood tests 93.83±21.89 percent, urinary tests 86.85±26.29 percent and sonograhic assessment of 95.7±4.3 percent. The conformity with desired situation of education about individual health and perinatal-risk assessment were 6.54±17.10 and 39.67±27.09 percent respectively. The results demonstrated 73.76±15.04 percent of clients’ satisfaction with the structure of prenatal care services and 70.54±13.13 percent of satisfaction with the care procedures. Conclusion: For the first time, this study assessed the prenatal care services in three dimensions of the services structure, care procedures and outcome of these services in the PNC clinics of Shahid Beheshti Medical Science University. The study aimed to provide a tool to assess quality of PNC area of reproductive health. Despite almost high quality obstetrical care and paraclinic tests, the quality of care in other care areas and the quality of clients’ education and counseling was moderate or low. Counseling and education are among the most important objectives of prenatal visits that needs precise planning and implementation. Screening of clients with psychosocial risks also requires special attention in prenatal care assessments. Preparing comprehensive forms for history taking, general and obstetrics assessments and would help to improve quality of prenatal care.