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Research ArticleOriginal ResearchA

Declining Trends in the Provision of Prenatal Care Visits by Family Physicians

Donna Cohen and Andrew Coco
The Annals of Family Medicine March 2009, 7 (2) 128-133; DOI: https://doi.org/10.1370/afm.916
Donna Cohen
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Andrew Coco
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  • Figure 1.
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    Figure 1.

    Proportion of national prenatal visits occurring in family physicians’ offices, 1995–2004.

    Note: National estimates based on 6,203 prenatal visits in the National Ambulatory Medical Care Survey, 1995–2004. For trend: P<.02.

  • Figure 2.
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    Figure 2.

    Proportion of prenatal visits occurring in family physicians’ offices in non-MSA areas, 1995–2004.

    Note: national estimates based on 925 prenatal visits in non–metropolitan statistical areas, from the National Ambulatory Medical Care Survey, 1995 – 2004. For trend: P=.03.

Tables

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    Table 1.

    Characteristics of Prenatal Visits to Family Physicians and Obstetricians, 1995–2004 (N = 6,203)

    Proportion of Visits (%)
    Patient CharacteristicsFamily Physician (n=481)Obstetrician (n=5,722)P Value
    Age, years
        <2447.031.2<.01
        24–3031.633.6
        >3021.435.2
    Race
        White87.883.0.09
        Black7.011.8
        Asian and other ethnicity5.25.2
        Latino17.614.5.39
    Health insurance
        Private49.363.9<.01
        Medicaid36.521.0
        Self-pay4.72.7
        Other9.512.4
    Geographic region
        Northeast9.014.0.07
        Midwest37.523.8
        South27.437.8
        West26.124.4
    Geographic entity
        Non–metropolitan statistical area46.012.2<.01
    Diagnoses
        High-risk condition15.512.9.21
    • View popup
    Table 2.

    Multivariate Logistic Regression Model Predicting Whether the Prenatal Visit Occurred With a Family Physician vs an Obstetrician

    Predictor VariableUnadjusted Odds Ratio (95% CI)AdjustedaOdds Ratio (95% CI)
    CI=confidence interval; MSA = metropolitan statistical area.
    a Odds ratio adjusted for all listed variables plus race, geographic region, and high-risk diagnoses.
    Non-MSA (vs MSA)6.13 (3.69 – 10.19)5.56 (3.23 – 9.62)
    Biennial period, per 2 years0.85 (0.74 – 0.97)0.81 (0.68 – 0.97)
    Age, years
        >300.40 (0.27 – 0.60)0.63 (0.41 – 0.95)
        24–300.62 (0.46 – 0.83)0.80 (0.58 – 1.08)
        <241.001.00
    Medicaid insurance2.25 (1.46 – 3.45)1.76 (1.10 – 2.82)
    Self-pay status2.26 (1.24 – 4.12)1.87 (0.95 – 3.67)
    Private insurance1.001.00

Additional Files

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  • The Article in Brief

    Declining Trends in the Provision of Prenatal Care Visits by Family Physicians

    Donna Cohen and colleagues

    Background Family physicians make an important contribution to maternity care, particularly in rural areas. The number of family physicians providing maternity care declined in the 1980s and 1990s, but there have been no recent studies showing whether and how these numbers have changed. This study measures the proportion of prenatal visits to family physicians between 1995 and 2004, and the characteristics of prenatal visits to family doctors as compared with those to obstetricians.

    What This Study Found Over a 10-year period, the proportion of prenatal visits to family physicians in the United Sates declined nearly 50%. Using data representing more than 244 million prenatal visits, researchers document a decrease in percentage of prenatal visits to family physicians from 11.6% to 6.1%. Family physicians are more likely than obstetricians to provide prenatal visits to women who are younger, live in rural areas, or have Medicaid insurance.

    Implications

    • Rural and medically underserved areas have experienced significant declines in maternity care by family physicians. This could affect women�s access to prenatal care in communities throughout the United States.
    • As family physicians provide less maternity care, it may be difficult to support family medicine-based curriculum, recruit faculty members, identify community role models, or develop sustainable models for residency graduates to include maternity care in their practices, leading to further declines in accessible prenatal care providers.
  • Annals Journal Club Selection:

    Mar/Apr 2009

    The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1

    How it Works

    In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.

    Article for Discussion

    • Cohen D, Coco A. Declining trends in the provision of prenatal care visits by family physicians. Ann Fam Med. 2009;7(2):128-133.

    Discussion Tips

    This article was recommended for discussion by the student and resident members of the Annals Editorial Advisory Board. It includes an analysis of a large nationally representative dataset showing a substantial downward trend in prenatal care by family physicians. The article by Coco2 in this issue may provide some additional useful context for your discussions.

    Discussion Questions

    • What question is addressed by the article? How does the question fit with what already is known on this topic?
    • How strong are the study design and data source for answering the question?
    • To what degree can the findings be accounted for by:
    1. How participants were selected?
    2. How outcomes were measured?
    3. Confounding (false attribution of causality because two variables discovered to be associated actually are associated with a 3rd factor)?
    4. Chance?
  • What are the main findings? What are the findings of subgroup analyses?
  • What do you think of the extrapolation of the findings from 6,203 visits to the entire population?
  • What are the implications of the findings for health care policy? At what level are policy changes needed (local, state, national; personal, by professional organizations and/or government)?
  • How do the findings of the study by Coco2 (also in this issue of the Annals) affect your interpretation of the policy implications?
  • What are the implications for the field of family medicine?
  • What are the implications of the findings for your training and practice plans? (Do you want to zig when many are zagging, or go with the trend?)
  • What creative solutions do you see for meeting the maternity care needs of underserved women?
  • What are some action next steps for you and other leaders and policy makers based on this study?
  • References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/cgi/content/full/4/3/196.
    2. Coco A. How often do physicians address other medical problems while providing prenatal care? Ann Fam Med. 2009;7(2):134-138.
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The Annals of Family Medicine: 7 (2)
The Annals of Family Medicine
Vol. 7, Issue 2
1 Mar 2009
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Declining Trends in the Provision of Prenatal Care Visits by Family Physicians
Donna Cohen, Andrew Coco
The Annals of Family Medicine Mar 2009, 7 (2) 128-133; DOI: 10.1370/afm.916

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Declining Trends in the Provision of Prenatal Care Visits by Family Physicians
Donna Cohen, Andrew Coco
The Annals of Family Medicine Mar 2009, 7 (2) 128-133; DOI: 10.1370/afm.916
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