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Research ArticleOriginal Research

Care From Family Physicians Reported by Pregnant Women in the United States

Katy B. Kozhimannil and Patricia Fontaine
The Annals of Family Medicine July 2013, 11 (4) 350-354; DOI: https://doi.org/10.1370/afm.1510
Katy B. Kozhimannil
1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis-St Paul, Minnesota
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Patricia Fontaine
2HealthPartners Institute for Education and Research, Bloomington, Minnesota
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  • For correspondence: patricia.l.fontaine@healthpartners.com
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    Figure 1

    Predicted probability that an average pregnant woman (aged 27 years, white, married, working, US-born citizen with high school education) reports having seen a family physician in the prior year, by US region.

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    Table 1

    Characteristics of Pregnant Women Responding to the US National Health Interview Surveys 2000–2009 (N = 3,204) and Odds of Reporting Care From a Family Physician

    CharacteristicDid Not See Family Physician No. (%)aSaw Family Physician No. (%)aReporting Care From a Family Physician AOR (95% CI)
    Total2,103 (65.6)1,101 (34.4)–
    Annual trend over time (2000–2009)––1.006 (0.996–1.016)
    Race/ethnicity
     Hispanic667 (31.7)268 (24.3)0.762 (0.501–1.159)
     Black391 (18.6)145 (13.2)0.485 (0.366–0.643)
     White860 (40.9)607 (55.1)Ref
     Other185 (8.8)81 (7.4)NAb
    US Region
     Northeast372 (17.7)141 (12.8)0.611 (0.494–0.757)
     North Central405 (19.3)293 (26.6)Ref
     South777 (36.9)413 (37.5)0.821 (0.667–1.009)
     West549 (26.1)254 (23.1)0.730 (0.598–0.891)
    Age, yc0.980 (0.968–0.991)
     <25628 (29.9)385 (35)–
     25–29625 (29.7)312 (28.3)–
     30–34529 (25.2)242 (22)–
     ≥35321 (15.3)162 (14.7)–
    Demographics
     Married1,390 (66.1)725 (65.8)0.882 (0.814–0.955)
     Working1,028 (48.9)551 (50)0.967 (0.586–1.134)
     US citizen1,640 (78)954 (86.6)1.069 (0.868–1.317)
     US born1,493 (71)907 (82.4)1.419 (0.932–2.160)
    Education
     Less than high school504 (24)214 (19.4)Ref
     High school degree1,005 (47.8)564 (51.2)1.155 (0.929–1.437)
     College degree340 (16.2)199 (18.1)1.288 (1.021–1.626)
     Graduate degree169 (8)92 (8.4)1.133 (1.023–1.255)
    Income, health, and health insurance
     Family income less than FPL399 (19)193 (17.5)1.123 (0.754–1.672)
     Poor or bad health101 (4.8)65 (5.9)1.446 (1.310–1.596)
     Currently uninsured309 (14.7)110 (10)NAb
     Currently publicly ensured (Medicaid)612 (29.1)329 (29.9)NAb
     Currently privately ensured1,067 (50.7)603 (54.8)NAb
    • AOR = adjusted odds ratio; FPL = federal poverty level; NA = not applicable; Ref = referent category.

    • ↵a Percentages reported as column percentages.

    • ↵b Used for variables not included in the final regression model.

    • ↵c Age was included in the regression model as a continuous variable.

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    Table 2

    Clinicians From Whom US Pregnant Women Reported Care in the Prior Year, 2000–2009 (N=3,204)

    ClinicianNo. (%)
    Any care from a clinician2,953 (92.2)
     Family physician1,101 (34.4)
     Obstetrician2,750 (85.8)
     Midwife, NP, or PA927 (28.9)
    Care from only 1 type of clinician1,128 (35.2)
     Family physician only121 (3.8)
     Obstetrician only962 (30.0)
     Midwife, NP, or PA only45 (1.4)
    Care from multiple types of clinicians2,076 (64.8)
     Family physician and obstetrician542 (16.9)
     Family physician and midwife, NP, or PA385 (12.0)
     Obstetrician and midwife, NP, or PA845 (26.4)
     Family physician, obstetrician, and midwife, NP, or PA348 (10.9)
    • NP=nurse practitioner; PA=physician assistant.

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    Care From Family Physicians Reported by Pregnant Women in the United States

    Patricia Fontaine , and colleagues

    Background Women receive medical care from many types of clinicians during pregnancy, including family physicians, obstetrician-gynecologists, midwives, other specialists, and midlevel clinicians. It is not known, however, how many pregnant women have family doctors. This analysis of nationally representative data from 2000 to 2009 describes the proportion of family physicians providing medical care of any sort to pregnant women in the United States and examines trends over time and by geographic region.

    What This Study Found Approximately one-third of pregnant women report having seen or talked to a family physician for medical care during the prior year, a percentage that has remained stable over the past decade. A substantial and steady proportion of pregnant women (36 percent) receive some care from family physicians, with most reporting receiving care from multiple types of clinicians, including family physicians, obstetrician-gynecologists, midwives, nurse practitioners, and physician assistants. There are regional differences in trends in family physician care, with pregnant women in the North Central United States increasingly reporting care from family physicians and women in the South reporting a decline.

    Implications

    • Because most pregnant women report care from multiple clinicians, care coordination is important for this patient population.
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The Annals of Family Medicine: 11 (4)
The Annals of Family Medicine
Vol. 11, Issue 4
July/August 2013
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Care From Family Physicians Reported by Pregnant Women in the United States
Katy B. Kozhimannil, Patricia Fontaine
The Annals of Family Medicine Jul 2013, 11 (4) 350-354; DOI: 10.1370/afm.1510

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Care From Family Physicians Reported by Pregnant Women in the United States
Katy B. Kozhimannil, Patricia Fontaine
The Annals of Family Medicine Jul 2013, 11 (4) 350-354; DOI: 10.1370/afm.1510
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Subjects

  • Person groups:
    • Women's health
  • Methods:
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  • Other research types:
    • Health services
  • Core values of primary care:
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    • Coordination / integration of care

Keywords

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  • pregnancy
  • maternal health services
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  • women’s health services

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