DOES THE CARE GIVEN BY GENERAL-PRACTITIONERS AND MIDWIVES TO PATIENTSWITH (IMMINENT) MISCARRIAGE MEET THE WISHES AND EXPECTATIONS OF THE PATIENTS

Objective. In 1989 a Dutch national guideline on (imminent) miscarriag e was developed for use in general practice. A prospective recording s tudy was carried out to determine how the patients evaluated the care they received from general practitioners (GPs) and midwives who agreed to adhere to this (imminent) miscarriage guideline and to determine t he aspects that influence this evaluation. Setting. GP practices and m idwifery practices in The Netherlands. Design. Prospective recording o f appointments during 4 consecutive weeks in a diary by patients who c ontacted their GP or midwife with symptoms of (imminent) miscarriage. Study participants. Over a period of 12 months, 75 GPs and 43 midwives recorded all patients (n = 407) showing symptoms of (imminent) miscar riage. In total 265 patients had completed at least the first contact in thr diary; 200 patients actually recorded all contacts. Results. Mo st patients gave their GP or midwife a high evaluation score (8.2 and 8.7 respectively). Yet, 20% thought that the care could be improved if the GP or midwife gave more information, was more empathetic and carr ied out an ultrasound scan. In determining the aspects that have most influence on the patients' evaluation, empathy and support came first, followed by involvement of the patient in decision making, putting he r at ease, and the total duration of the contacts. Although patients w ho wanted a referral gave a lower score, this seems to be of less impo rtance than the above mentioned aspects. Expecting and getting an ultr asound scan did not influence the patient's evaluation.