当前位置： SCI文献检索 > OBSTETRICS AND GYNECOLOGY期刊下所有文献 > Patient Experiences With Miscarriage Management in the Emergency and Ambulatory Settings.

Patient Experiences With Miscarriage Management in the Emergency and Ambulatory Settings.

Abstract：

OBJECTIVE:To quantitatively and qualitatively describe the patient experience for clinically stable patients presenting with miscarriage to the emergency department (ED) or ambulatory clinics. METHODS:We present a subanalysis of a mixed-methods study from 2016 on factors that influence miscarriage treatment decision-making among clinically stable patients. Fifty-four patients were evaluated based on location of miscarriage care (ED or ambulatory-only), and novel parameters were assessed including timeline (days) from presentation to miscarriage resolution, number of health system interactions, and number of specialty-based provider care teams seen. We explored themes around patient satisfaction through in-depth narrative interviews. RESULTS:Median time to miscarriage resolution was 11 days (range 5-57) (ED) and 8 days (range 0-47) (ambulatory-only). We recorded a mean of 4.4±1.4 (ED) and 3.0±1.2 (ambulatory-only) separate care teams and a median of 13 (range 8-20) (ED) and 19 (range 8-22) (ambulatory-only) health system interactions. Patients seeking care in the ED were younger (28.3 vs 34.0, odds ratio [OR] 5.8, 95% CI 1.8-18.7), more likely to be of black race (28.3 vs 34.0, OR 3.3, 95% CI 1.1-10.0), uninsured or insured through Medicaid (16 vs 6, OR 6.8, 95% CI 2.1-22.5), and more likely to meet criteria for posttraumatic stress disorder when compared with ambulatory-only patients (10 vs 3, OR 6.0, 95% CI 1.5-23.4). Patients valued diagnostic clarity, timeliness, and individualized care. We found that ED patients reported a lack of clarity surrounding their diagnosis, inefficient care, and a mixed experience with health care provider sensitivity. In contrast, ambulatory-only patients described a streamlined and sensitive care experience. CONCLUSION:Patients seeking miscarriage care in the ED were more likely to be socioeconomically and psychosocially vulnerable and were less satisfied with their care compared with those seen in the ambulatory setting alone. Expedited evaluation of early pregnancy problems, with attention to clear communication and emotional sensitivity, may optimize the patient experience.

journal_name

Obstet Gynecol

journal_title

Obstetrics and gynecology

authors

Miller CA,Roe AH,McAllister A,Meisel ZF,Koelper N,Schreiber CA

doi

10.1097/AOG.0000000000003571

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

1285-1292

issue

eissn

0029-7844

issn

1873-233X

pii

00006250-201912000-00021

journal_volume

134

pub_type

杂志文章

在线工具

Patient Experiences With Miscarriage Management in the Emergency and Ambulatory Settings.