Do patients matter? Contribution of patient and care provider characteristics to the adherence of general practitioners and midwives to the Dutch national guidelines on imminent miscarriage

Do patients matter? Contribution of patient and care provider characteristics to the adherence of general practitioners and midwives to the Dutch national guidelines on imminent miscarriage

Fleuren, M.
van der Meulen, M.
Wijkel, D.

2000

Objective - To assess the relative contribution of patient and care provider characteristics to the adherence of general practitioners (GPs) and midwives to two specific recommendations in the Dutch national guidelines on imminent miscarriage. The study focused on performing physical examinations at the first contact and making a follow up appointment after 10 days because these are essential recommendations and there was much variation in adherence between different groups of providers. Design - Prospective recording by GPs and midwives of care provided for patients with symptoms of imminent miscarriage. Setting - General practices and midwifery practices in the Netherlands. Subjects - 73 GPs and 38 midwives who agreed to adhere to the guidelines; 391 patients were recorded during a period of 12 months. Main measures - Adherence to physical examinations and making a follow up appointment were measured as part of a larger prospective recording study on adherence to the guidelines on imminent miscarriage. Patient and care provider characteristics were obtained from case recordings and interviews, respectively. Multilevel analysis was performed to assess the contribution of several care provider and patient characteristics to adherence to two selected recommendations: the number of recommended physical examinations at the first contact and the number of days before a follow up appointment took place. Results -In the multilevel model explaining variance in adherence to physical examinations, the care provider's acceptance of the recommendations was the most important factor. Severity of symptoms and referral to an obstetrician were significant factors at the patient level. In the model for follow up appointments the characteristics of the care provider were less important. Referral to an obstetrician and probability diagnosis were significant factors at the patient level. Conclusions - The study showed that characteristics of both the patient and care provider contribute to the variability in adherence. Furthermore, the contribution of the characteristics differed per recommendation. It is therefore advised that the contribution of both patient and care provider characteristics per recommendation should be carefully examined. If implementation is to be successful, strategies should be developed to address these specific contributions.

Health
Guidelines
Implementation
Miscarriage
Clinical examination
Clinical practice
Comparative study
Controlled study
Follow up
General practitioner
Imminent abortion
Maternal treatment
Midwife
Patient attitude
Patient monitoring
Practice guideline
Primary medical care
Treatment outcome
Abortion, Spontaneous
Abortion, Threatened
Adolescent
Adult
Family Practice
Female
Guideline Adherence
Humans
Midwifery
Netherlands
Patient Compliance
Patient Education
Physical Examination
Practice Guidelines
Pregnancy
Prospective Studies
Sensitivity and Specificity
Ultrasonography, Interventional

http://resolver.tudelft.nl/uuid:235d03fe-8b51-401d-ac70-0ff55787f3a9

https://doi.org/10.1136/qhc.9.2.106

235564

0963-8172

Quality in Health Care, 9 (2), 106-110

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