Annals Journal Club: The Decline of Maternity Care in Family Medicine

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?