周產期整合性轉診照護之現況調查：以高屏區為例

Investigation of an integrated referral perinatal care: An example of Kaohsiung-Pingtung area

陳靜如(Ching-Ju Chen)

指導教授 ： 周汎澔

高雄醫學大學/護理學院/護理學系碩士班/碩士(2015年)

摘要

近十年來因社會經濟變遷、就醫行為改變，生產環境改變以及剖腹產率居高不下，造成高危險性新生兒發生率增加，以致周產期高危險性孕產婦及新生兒的轉診率亦逐年提高。許多高風險妊娠與胎兒自體健康狀況，使得其中在出生時仍有40％需要接受急救，且約有1/3的新生兒死亡發生於出生後24小時內。由此可見，周產期整合性轉診對於高危險性新生兒的重要性，但相關資料仍很少。本研究運用次級資料分析「周產期轉診整合性照護品質提升計畫」自擬問卷，加以探討受訪的50家周產期醫療院所的資料，目的旨在調查高屏地區周產期整合轉診照護的現況，針對高危險性新生兒轉診分析結果如下：1.屏東恆春地區接生執業機構已顯著減少，產婦可能跨區至高雄市或其他縣市就醫生產。2.多數機構不具備高危險性新生兒轉送相關設備與人力，且因考量接受轉診院所的照護能力，而優先選擇醫學中心為轉出機構。3.有22.86%的機構人員不曾參加過該課程並取得急救證照，一旦遇到突發狀況的新生兒，其篩選診斷與處置危急新生兒的能力將面臨考驗，且可能不利高危險性新生兒的轉診預後。本研究藉由分析「周產期轉診整合性照護品質提升計畫」中的調查問卷以及共識會議紀錄，了解高屏地區周產期尤以高危險性新生兒轉診現況，可作為在擬定未來雙向轉診模式的參考。

關鍵字

周產期 ； 整合性照護 ； 轉診

並列摘要

Over the past decade due to the socio-economic, medical behavior, and the reproduction environmental changes and the prevalence of selective caesarean section, resulting in increased incidence of high-risk newborns develops. Therefore, the referral rates of high-risk perinatal maternal and newborn also increase year after year. Among these babies, there is still up to 40% of them who need the emergent aid right after birth, and about one-third of neonatal deaths occur within 24 hours after birth. Thus, the importance of integrated perinatal and high-risk newborns referral care cannot be ignored. However, the relevant information is still poorly studied. In this study, we use the secondary data analysis with the questionnaire which were collected from 50 perinatal medical institutions among this area by "Integrated Perinatal referral care quality improvement program". This program aims to investigate the status of perinatal integration referral care at the Kaohsiung-Pingtung area. Our analysis of high-risk neonatal referral results are as follows: 1. According to the less and less physicians practicing in obstetrics in Hengchun, and Pingtung region, there are more and more pregnant women living in this area give a birth in Kaohsiung or other counties. 2. The insufficiency of the equipment and manpower for transferring the high-risk newborn were noted in most institutions, and almost all high risk newborn are transferred to medical centers because of the capability. 3. There are up to 22.86% of medical staff in these institutions who aren’t qualified for the NRP license. Therefore, the first aid to these high risk newborns are crucial, and there is the possible worsening influence on the babies’ prognosis. By analyzing with the questionnaire, and a consensus record of meeting in " Integrated Perinatal referral care quality improvement program " , our study revealed the current situation in the perinatal period especially in high-risk newborn referral care in Kaohsiung- Pingtung area, and as in the reference for the future safety and efficiency high risk newborn referral patterns.

並列關鍵字

prenatal ； integrated care ； referral

參考文獻

中文文獻

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