Article Figures & Data
Figures
- Figure 1.
Selection of prenatal visits, NAMCS 1995–2004.
ICD-9-CM=International Classification of Diseases, 9th Revision, Clinical Modification; NAMCS=National Ambulatory Medical Survey.
Note: The following primary diagnoses were included as prenatal visits: normal pregnancy (ICD-9-CM code V22), supervision of high-risk pregnancy (ICD-9-CM code V23), hemorrhage in early pregnancy (ICD-9-CM code 640), antepartum hemorrhage/abruptio placentae/placenta previa (ICD-9-CM code 641), hypertension complicating pregnancy/birth/puerperium (ICD-9-CM code 642), excessive vomiting in pregnancy (ICD-9-CM code 643), early or threatened labor (ICD-9-CM code 644), prolonged pregnancy (ICD-9-CM code 645), other complications of pregnancy, not elsewhere classified (ICD-9-CM code 646), infection/parasite condition in mother classified elsewhere/complicated pregnancy/birth/puerperium (ICD-9-CM code 647), other current condition in mother classified elsewhere but complicating pregnancy/birth/puerperium (ICD-9-CM code 648), multiple gestation (ICD-9-CM code 651), malposition-unspecified (ICD-9-CM code 652), fetopelvic disproportion (ICD-9-CM code 653), abnormality of organs and soft tissues of pelvis (ICD-9-CM code 654), known or suspected fetal abnormality affect management of mother (ICD-9-CM code 655), other fetal and placental problems affecting management of mother (ICD-9-CM code 656), other problems associated with amniotic cavity and membranes (ICD-9-CM code 658), other indication for care/intervention related to labor/delivery not elsewhere classified (ICD-9-CM code 659), venous complications in pregnancy and the puerperium (ICD-9-CM code 671), and obstetric pulmonary embolism (ICD-9-CM code 673).
- Figure 2.
Selection of prenatal visits with a secondary and/or tertiary nonobstetrical diagnosis, NAMCS 1995–2004.
Tables
- Table 1.
Visit Counts by ICD-9-CM Diagnostic Categories for Prenatal Visits with 1 or More Secondary and Tertiary Non–Pregnancy-Related Diagnoses, NAMCS 1995–2004
ICD-9-CM=International Classification of Diseases, 9th Revision, Clinical Modification; NAMCS = National Ambulatory Medical Care Survey. Visits to obstetricians (ICD-9-CM diagnostic category) Infectious and parasitic diseases (001–139) 37 Neoplasms (140–239) 5 Endocrine, nutritional and metabolic diseases, and immunity disorders (240–279) 65 Diseases of the blood and blood-forming organs (280–289) 20 Mental disorders (290–319) 21 Diseases of the nervous system and sense organs (320–389) 6 Diseases of the circulatory system (390–459) 4 Diseases of the respiratory system (460–519) 22 Diseases of the digestive system (520–579) 8 Diseases of the genitourinary system (580–629) 54 Diseases of the skin and subcutaneous tissue (680–709) 6 Diseases of the musculoskeletal system and connective tissue (710–739) 13 Congenital anomalies (740–759) 1 Symptoms, signs, and ill-defined conditions (780–799) 62 Injury and poisoning (800–999) 3 Supplementary classification of factors influencing health status and contact with health services (V01-V85) 106 Total 433 Visits to family physicians (ICD-9-CM diagnostic category) Infectious and parasitic diseases (001–139) 6 Neoplasms (140–239) 0 Endocrine, nutritional and metabolic diseases, and immunity disorders (240–279) 2 Diseases of the blood and blood-forming organs (280–289) 2 Mental disorders (290–319) 14 Diseases of the nervous system and sense organs (320–389) 0 Diseases of the circulatory system (390–459) 2 Diseases of the respiratory system (460–519) 11 Diseases of the digestive system (520–579) 2 Diseases of the genitourinary system (580–629) 13 Diseases of the skin and subcutaneous tissue (680–709) 0 Diseases of the musculoskeletal system and connective tissue (710–739) 5 Congenital anomalies (740–759) 1 Symptoms, signs, and ill-defined conditions (780–799) 13 Injury and poisoning (800–999) 2 Supplementary classification of factors influencing health status and contact with health services (V01-V85) 10 Total 83 - Table 2.
Characteristics of Prenatal Visits to Office-Based Family Physicians and Obstetricians, 1995–2004 (N = 6,203)
Proportion of Visits, % Characteristic Family Physician (n=481) Obstetrician (n=5,722) Pvalue ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification. a Data available only for 2003 and 2004. b Primary diagnosis of supervision of high-risk pregnancy (ICD-9-CM code V23) or complications of pregnancy, childbirth, and the puerperium (ICD-9-CM codes 640–648, 652–556, 658, 658, 671, and 673). Age, years 47.0 31.2 <.01 <24 31.6 33.6 <.01 24–30 21.4 35.2 >30 Race 87.8 83.0 .09 White 7.0 11.8 .09 Black/African American 5.2 5.2 .39 Asian and other ethnicity 17.6 14.5 Latino Health insurance 49.3 63.9 <.01 Private 36.5 21.0 <.01 Medicaid 4.7 2.7 <.01 Self-pay 9.5 12.4 Other 91.5 26.7 Primary care physiciana 15.5 12.9 .21 High-risk diagnosisb 17.6 7.8 <.01 Concurrent diagnosis 17.6 7.8 <.01 - Table 3.
Multivariate Logistic Regression Model Predicting Whether the Prenatal Visit Included 1 or More Secondary and Tertiary Nonobstetric Diagnoses
Predictor Variable Unadjusted OR (95% CI) AdjustedaOR (95% CI) CI=confidence interval; OR = odds ratio. a Adjusted for age, insurance status, and Latino ethnicity. Family physician (vs obstetrician) 2.52 (1.78–3.58) 2.57 (1.82–3.64) Nonwhite race (vs white race) 1.31 (1.00–1.74) 1.36 (1.03–1.81)
The Article in Brief
How Often Do Physicians Address Other Medical Problems While Providing Prenatal Care?
Andrew Coco
Background Family physicians often address multiple problems during patient visits. This study compares the extent to which family physicians and obstetricians diagnose other medical problems while providing prenatal care.
What This Study Found Family physicians diagnosed other medical problems not related to the pregnancy during 18% of prenatal visits, compared with 8% for obstetricians. Family physicians served as both primary care doctor and prenatal care provider during 92% of maternity care visits; fewer than 27% of obstetricians served as their maternity patients' primary care doctor.
Implications
- Prenatal care by family physicians can benefit women by receiving care for multiple health problems in a single visit.
- A decline in prenatal care by family physicians could affect access to nonobstetrical services for pregnant women.
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