HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) In Brief TRACK Discussion: Submit a Comment TRACK Discussion: View Comments Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coco, A. Search for Related Content PubMed PubMed Citation Articles by Coco, A. Related Collections Women's health Quantitative methods Health services Professional practice Multimorbidity

How Often Do Physicians Address Other Medical Problems While Providing Prenatal Care?

The Lancaster General Research Institute, and the Department of Family and Community Medicine, Lancaster General Hospital, Lancaster, Pennsylvania

CORRESPONDING AUTHOR: Andrew Coco, MD, MS, Medical Research Institute, Lancaster General Hospital, 555 N Duke St, Lancaster, PA 17604, ascoco{at}lancastergeneral.org

PURPOSE It is unknown to what extent physicians address multiple problems while providing prenatal care. The objective of this study was to determine the percentage of prenatal encounters with 1 or more secondary and tertiary nonobstetric diagnoses and compare rates between family physicians and obstetricians.

METHODS Using the National Ambulatory Medical Care Survey, 1995–2004, I analyzed prenatal visits to family physicians’ and obstetricians’ offices. The outcome measure was the percentage of prenatal encounters with 1 or more secondary and tertiary nonobstetric diagnoses seen by family physicians and obstetricians.

RESULTS There were 6,203 visit records that met study criteria, representing 223 million visits to obstetricians and 21 million visits to family physicians. Of the prenatal encounters with a family physician, 17.6% (95% confidence interval [CI], 12.9%–22.4%) included 1 or more secondary and tertiary nonobstetric diagnoses compared with 7.8% (95% CI, 6.1%–9.6%) of prenatal encounters with an obstetrician (P <.01). After controlling for other variables, being seen by a family physician, compared with being seen by an obstetrician, remained an independent predictor of a prenatal visit with an additional nonobstetric diagnosis (OR = 2.57; 95% CI, 1.82–3.64).

CONCLUSIONS Family physicians diagnose nonobstetric problems frequently and considerably more often than obstetricians while providing prenatal care. This practice style enhances access to comprehensive primary care for women.

Key Words: Prenatal care • comorbidity • concurrent diagnoses • family medicine

This article has been cited by other articles:

				R. S. Gotler and K. C. Stange A Way Forward for Health Care and Healers Ann. Fam. Med, May 1, 2009; 7(3): 273 - 274. [Full Text] [PDF]

				W. R. Phillips In This Issue: Practice, Research, and Reflection Ann. Fam. Med, March 1, 2009; 7(2): 98 - 99. [Full Text] [PDF]

				D. Cohen and A. Coco Declining Trends in the Provision of Prenatal Care Visits by Family Physicians Ann. Fam. Med, March 1, 2009; 7(2): 128 - 133. [Abstract] [Full Text] [PDF]

				Annals Journal Club: The Decline of Maternity Care in Family Medicine Ann. Fam. Med, March 1, 2009; 7(2): iii - iii. [Full Text] [PDF]

TRACK Comments: