10/10/2017 - 13:45 - 14:40
Apresentações |
18369 - BARRIERS AND ENABLERS IN THE IMPLEMENTATION OF A QUALITY IMPROVEMENT FOR CESAREAN SECTIONS PROGRAM
CLARA BERMUDEZ-TAMAYO - ANDALUSIAN SCHOOL OF PUBLIC HEALTH, EMILIA FERNÁNDEZ RUIZ - ASOCIACIÓN DE MUJERES POLITÓLOGAS, GUADALUPE PASTOR MORENO - ANDALUSIAN SCHOOL OF PUBLIC HEALTH, GRACIA MAROTO-NAVARRO - ANDALUSIAN SCHOOL OF PUBLIC HEALTH, LETICIA GARCIA-MOCHON - ANDALUSIAN SCHOOL OF PUBLIC HEALTH, FRANCISCO JOSE PEREZ-RAMOS - CONSEJERÍA DE IGUALDAD, SALUD Y POLÍTICAS SOCIALES. JUNTA DE ANDALUCÍA., AFRICA CAñO-AGUILAR - UGC OBSTETRICS AND GYNAECOLOGY HOSPITAL UNIVERSITARIO SAN CECILIO, MARIA DEL PILAR VELEZ - DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, KINGSTON GENERAL HOSPITAL, QUEEN'S UNIVERSITY
Background: Conducting audits, implementing best practices and giving feedback have shown considerable promise in reducing rates of cesarean delivery (CD).Objectives:a) to identify the factors that facilitate change in current practices and thus reduce the use of obstetric interventions, perceived by professionals participating in a program in Andalusia (Spain),b)to better understand the barriers to such changes.
Methods: Qualitative study.Participants were 14 ob-gyns and 14 nurse-midwives who work for Spain's NHS and have been involved in the program.In-depth individual interviews were used,to examine factors affecting quality of care,related to policy/management, hospitals,practitioners and patients.
Results: Barriers:1)policy/management level: limited influence of institutional policy and the scant political commitment perceived.2)organizational level:separation of the hierarchical structure of doctors from that of nurse-midwives, few positive incentives and the strong threat of sanctions for malpractice, inappropriate reorganization of midwife/ObGyns competences, 3)Healthcare facility: reluctance to change accentuated by years of professional practice. 4)Physical resources: obsolete delivery rooms with a medical look, 5)professional level: legal pressure,CD considered a safe-conduct in the event of a legal claim, low motivation due to decline in working conditions,convenience-based practices. 6)Woman: fear of pain, impatience while waiting for process to occur, misinformation.Enablers:1)organizational level:good coordination with pediatrics and emergency departments,2)Training: skill updates for a less-interventionist approach,increased awareness,3)Health professionals: satisfaction for a job well done, recognition by patients.4)Woman: information circuits for patients and their families, trust in health professionals.
Conclusions:Results can contribute to the design of effective knowledge translation interventions based on overcoming obstacles,reinforcing enabling factors and attempting to (re)define the boundaries between research and practice.
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