Construction of the Base of Pre-pregnancy Health Care Network:a Community-based Exploration

doi:10.12114/j.issn.1007-9572.2020.00.042

Abstract

Abstract: Background　China is a country in which the incidence of birth defects is high，and is increasingly becoming a prominent public health and social issue.To reduce birth defects，Guidelines for Pre-pregnancy and Pregnancy Care has been promulgated and updated by relevant authoritative departments，and free eugenics prenatal testing has been carried out nationally.However，the rate of undergoing this kind of examination is unsatisfied，which may be caused by insufficient propaganda and other reasons.Currently，there is a shortage of pre-pregnancy health education professionals in the community.Objective　To summarize the exploring experience of Baoshan District Songnan Town Community Health Center in the construction of the base of pre-pregnancy health care network.Methods　From March to December 2018，Songnan Town Community Health Center developed a community-based prepregnancy care management network by referring to the effective model for unified management of the integrated health and family planning systems，and a community-based perinatal healthcare network covering health services，family planning guidance and management，and trained a community-based prepregnancy care management team for widely publicizing information about eugenic birth and the national policy of free eugenics prenatal testing，as well as provided hierarchical prenatal services by cooperating with higher level hospitals.Pre- and post-training surveys were conducted in a community-based prepregnancy care management team for evaluating their level of eugenic knowledge.Pre- and post-publicity surveys were conducted in a service population for collecting data concerning history of adverse pregnancy outcomes，awareness levels of national policy of free eugenics prenatal testing，and eugenic birth knowledge，needs of prenatal healthcare，and status of undergoing eugenics prenatal testing.Results　After training，all the members of the community-based prepregnancy care management team showed higher awareness levels of contents of free eugenics prenatal testing，time and reasons of taking folic acid，and suitable time for getting pregnancy after induced abortion（P<0.05）.A total of 438 service people （221 couples，and either one spouse of other 19 couples） received prenatal healthcare education.After receiving education，the prevalence rate of knowing the national policy of free eugenics prenatal testing in these people increased to 100.0% from that〔82.0%（359/438）〕 at baseline.Moreover，the prevalence rates of knowing preparing time for a healthy pregnancy，toxic substances that should not be exposed to before pregnancy，information related to a healthy pregnancy，and start time for taking folic acid also increased significantly（P<0.05）.Furthermore，96 couples（40.0%）underwent eugenics prenatal testing or made an appointment after receiving the education.In 2017，76 couples underwent the free eugenics prenatal testing，which was lower than the goal（83 couples） set by Songnan Town Community Health Center using the original prenatal management，but in 2018，the center used this new prenatal management，95 couples underwent the free eugenics prenatal testing，exceeding the set goal（75 couples）.Conclusion　Our newly developed community-based prepregnancy care management network showed high levels of management and professional performances，with satisfied social publicity and policy implementation capabilities，and enriched prenatal services by providing hierarchical services via cooperating with higher level hospitals.In view of this，it may be has a broad application prospect.

Key words: Preconception care, Health education, Construction of network base, Hierarchical treatment, Vertical linkage

摘要： 背景　我国是出生缺陷高发国家，出生缺陷日益成为突出的公共卫生和社会问题。为降低出生缺陷，相关权威部门颁布并更新了《孕前与孕期保健指南》，国家实行免费孕前优生健康检查。由于宣传力度不够等原因，国家免费政策遇冷。目前社区缺少孕前健康教育专业人员。目的　总结上海市宝山区淞南镇社区卫生服务中心（简称中心）在孕前保健网底建设探索中取得的经验。方法　2018年3—12月，中心利用卫生计生系统合二为一、统一管理的有效模式，将卫生服务、计生指导与管理整合后的社区孕产期保健管理网络为基础，创建社区孕前保健管理网络，培养社区孕前保健管理队伍，广泛宣传孕前优生知识和国家免费孕前优生健康检查政策，将分级诊疗、上下联动的医疗模式运用于孕前保健。于宣传前后，对社区孕前保健管理队伍成员开展孕前优生知识知晓情况的调查；对服务对象开展不良孕产史、国家免费政策知晓情况、孕前优生知识知晓情况、孕前保健知识需求情况、孕前优生健康检查情况的调查。结果　淞南镇共240对夫妇438例接受了孕前保健健康教育服务。宣教后，孕前保健管理队伍成员免费孕前检查服务内容、服用叶酸时间、服用叶酸原因、人工流产后适宜受孕时间知晓率均高于宣教前（P<0.05）。宣教后，438例（100.0%）服务对象均知晓国家免费政策，高于宣教前的359例（82.0%）（P<0.05）。宣教后，服务对象孕前健康准备时间、孕前不宜接触的毒害物、孕前健康准备内容、开始服用叶酸时间知晓情况均高于宣教前（P<0.05）。宣教后，96对（40.0%）夫妇已作或已预约孕前优生健康检查。2017年按照原来的工作模式，免费孕前优生健康检查数未完成目标任务，目标任务83对，实际完成76对；2018年按照新的孕前保健工作模式，免费孕前优生健康检查数超额完成目标任务，目标任务75对，实际完成95对。结论　新创建的社区孕前保健管理网络具有较强的管理能力和专业优势，又具有成熟的社会宣传和政策执行能力，通过分级诊疗、上下联动的医疗模式拓展了社区孕前保健服务内涵，此模式运用前景广阔；对育龄夫妇进行一级干预，符合我国当下的形势需求，其简单易行、操作性较强、经济成本低、作用范围广，值得推广。

关键词: 孕前保健, 健康教育, 网底建设, 分级诊疗, 上下联动

LIN Meijuan,QIAN Xiaozhong,CHEN Xiong, et al. Construction of the Base of Pre-pregnancy Health Care Network:a Community-based Exploration　[J]. Chinese General Practice, 2020, 23(5): 580-584. DOI: 10.12114/j.issn.1007-9572.2020.00.042.
林美娟,钱晓忠,陈雄等. 社区孕前保健网底建设探索研究[J]. 中国全科医学, 2020, 23(5): 580-584. DOI: 10.12114/j.issn.1007-9572.2020.00.042.

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