The Evaluation Of The Effects Of Clinical Pathway For Placing Intrauterine Device To Women Of Childbearing Age Living In Rural Areas

Objective:This study applied the clinical pathway(CP) for implementing intrauterine device(IUD) in rural areas,analyzed and explored the influence of the CP management over the quality of life(QOL) of women of childbearing age,the complication rate and the satisfaction rate of IUD service,evaluated the effect and feasibility in order to provide the basis for further the improvement of the CP for placing IUD in rural areas.Method:The study stratified random sampling was utilized in this study to extract two countries from An hui and Yunnan provinces randomly and respectively(assigned as the CP group and nonclinical pathway group randomly),and to choose country family planning service station and three village family planning service stations randomly as the survey places,and randomly select survey objects from the women of childbearing age who came to the survey stations for IUD placement from January 1,2015 to March 31,2015.Nonclinical pathway(NCP) group placed IUD conventionally,CP group placed as clinical pathway flow.And we evaluated the QOL of objects,and the complication rate of IUD and the satisfaction rate of IUD service through《The study of clinical pathway for placing intrauterine device to women of childbearing age living in rural areas---service object questionnaire》.SPSS17.0 was used to analyze the data,and evaluated the effect of clinical pathway,finally analyzed the variation factors existed in the implementation process.Result:1.CP group and NCP group had no statistically significant differences in the aspect of age(c2=5.703,P>0.05),occupation(c2=2.248,P>0.05),marital status(c2=6.083, P>0.05),the degree of education(c2=7.481,P>0.05),station(counties or villages)(t=0.668,P>0.05),or whether used IUD ever(c2=2.885,P>0.05). 2.Complication rate comparison:CP group showed 109 complications, accounting for 5.7%,NCP group showed 226 complication,accounting for 12.0%,the CP group is significantly less compared with NCP group(c2=46.105,P<0.05). 3.Satisfaction rate of IUD service comparison:CP group showed a higher satisfaction rate compared with NCP group in the aspect of propaganda counseling(c2=20.181,P<0.05),sevvice attitude(c2=79.447,P<0.05),quality of service(c2=28.947,P<0.05),and follow-up status(c2=179.803,P<0.05). 4.QOL score comparison: In addition to physical functioning dimension,the score of CP group significantly higher compared with NCP group(P < 0.05). 5.Variation analysis:There were 1910 objects in CP group.121 cases were negative variation.There were 92.5% cases caused by the women through complications and exited the path.There were 1.7% cases caused by medical staff,mainly because stop as the subjects.There were 5.8% cases caused by both medical staff and women,mainly due to the cease of follow-up.Conclusion:1.Better clinical pathway for placing IUD could reduce the complication rate, and improve the QOL and satisfaction rate of objects.In addition,the regulation of the operation of the medical staff could help to improve the operation quality of medical staff and to provide constantly improving and optimizing medical service to women of childbearing age. 2.The variation of CP for implementing IUD in rural areas were all negative variation.The main reason was complications of women of childbearing age,and the most was intrauterine device ectopic and completely detached.