This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Annals of Family Medicine Study
Role of FPs in Prenatal Care Declining Even in Rural Areas
An overall decline in the provision of maternity care by family physicians has been well documented, but a recent study in the Annals of Family Medicine reports that the percentage of prenatal care provided by FPs is falling even more dramatically in rural areas.
Of 244.5 million prenatal visits made between 1995 and 2004, the percentage made to family physicians decreased from 11.6 percent in 1995-96 to 6.1 percent in 2003-04, says a recent study published in the Annals of Family Medicine. The percentage of visits made to FPs in rural areas fell even more drastically during that period, from 38.6 percent to 12.9 percent.
The study was based on 1995-2004 data gathered as part of the ongoing National Ambulatory Medical Care Survey. The study's goal was twofold:
- to measure the trend in the proportion of prenatal visits made to family physicians during the 10-year study period and
- to determine the characteristics of prenatal visits made to family physicians with those made to obstetricians.
Overall, the percentage of prenatal visits provided by family physicians decreased from 11.6 percent in 1995-96 to 6.1 percent in 2003-04, according to the study, and the percentage of such visits to FPs in rural areas fell from 38.6 percent to 12.9 percent during that period.
Donna Cohen, M.D., associate director of the Lancaster General Health Family Medicine Residency Program in Lancaster, Pa., and co-author of the study, said in an interview with AAFP News Now that the drop in prenatal care services provided by family physicians in rural areas -- designated as "non-metropolitan statistical areas," or non-MSAs, by the Office of Management and Budget -- could not be attributed to an increase in obstetricians serving in those areas. The study -- which reviewed 244.5 million prenatal visits from 1995 to 2004 -- found that prenatal visits in these areas were 5.6 times more likely to occur with a family physician than an obstetrician.
The study authors also noted that the overall number of prenatal visits per biannual period in non-MSAs remained stable during the overall 10-year period of the study, and it was unclear why the role of FPs was declining at an even more rapid rate in non-MSAs than in metropolitan areas.
According to Cohen, closure of some rural hospital maternity wards is one possible explanation for the declining role of FPs in prenatal care, and insurance issues also might be a factor. The study points out that one-third of the prenatal visits made to family physicians were by Medicaid beneficiaries and notes that Medicaid patients are more likely to enter prenatal care late or receive fewer prenatal visits than privately insured women. Overall, wrote the authors, FPs were more likely than obstetricians to provide prenatal visits to young women who live in rural areas or have Medicaid insurance.
Cohen said that if women in non-MSAs have to travel long distances for office visits, they likely will make fewer visits than pregnant women living in urban areas. That, she added, could lead to poor follow-up and safety concerns for those patients.
Cohen and co-author Andrew Coco, M.D., wrote that the decline in prenatal care could explain a similar slide in the proportion of outpatient care services family physicians are providing to children compared with that seen 10 years ago.
Cohen said she plans to follow up with a similar study comparing the percentage of well-child visits family physicians provide compared with those provided by pediatricians.
The researchers said in the recently published study that the declining role of family physicians in prenatal and maternity care could affect the specialty in the long term, including family medicine training.
"The training aspect still needs to be there," Cohen told AAFP News Now. "There are still residents committed to (obstetric) care and prenatal care. I don't think that will change that much. My only real concern is that we reach a point that there will be (fewer) people trained to teach. Down the road, there will be (fewer) and (fewer) people available for that."
In a related study in the same issue of Annals, Coco reports that women actually receive more comprehensive care from family physicians, compared with obstetricians, during prenatal care visits. Coco studied 223 million visits to obstetricians and 21 million visits to family physicians and found that 17.6 percent of the visits with FPs included secondary and tertiary nonobstetric diagnoses compared with 7.8 percent of prenatal visits with obstetricians that included such additional diagnoses.
Donna Cohen, M.D., associate director of the Lancaster General Health Family Medicine Residency Program in Lancaster, Pa., and co-author of the study, said in an interview with AAFP News Now that the drop in prenatal care services provided by family physicians in rural areas -- designated as "non-metropolitan statistical areas," or non-MSAs, by the Office of Management and Budget -- could not be attributed to an increase in obstetricians serving in those areas. The study -- which reviewed 244.5 million prenatal visits from 1995 to 2004 -- found that prenatal visits in these areas were 5.6 times more likely to occur with a family physician than an obstetrician.
The study authors also noted that the overall number of prenatal visits per biannual period in non-MSAs remained stable during the overall 10-year period of the study, and it was unclear why the role of FPs was declining at an even more rapid rate in non-MSAs than in metropolitan areas.
According to Cohen, closure of some rural hospital maternity wards is one possible explanation for the declining role of FPs in prenatal care, and insurance issues also might be a factor. The study points out that one-third of the prenatal visits made to family physicians were by Medicaid beneficiaries and notes that Medicaid patients are more likely to enter prenatal care late or receive fewer prenatal visits than privately insured women. Overall, wrote the authors, FPs were more likely than obstetricians to provide prenatal visits to young women who live in rural areas or have Medicaid insurance.
Cohen said that if women in non-MSAs have to travel long distances for office visits, they likely will make fewer visits than pregnant women living in urban areas. That, she added, could lead to poor follow-up and safety concerns for those patients.
Cohen and co-author Andrew Coco, M.D., wrote that the decline in prenatal care could explain a similar slide in the proportion of outpatient care services family physicians are providing to children compared with that seen 10 years ago.
Cohen said she plans to follow up with a similar study comparing the percentage of well-child visits family physicians provide compared with those provided by pediatricians.
The researchers said in the recently published study that the declining role of family physicians in prenatal and maternity care could affect the specialty in the long term, including family medicine training.
"The training aspect still needs to be there," Cohen told AAFP News Now. "There are still residents committed to (obstetric) care and prenatal care. I don't think that will change that much. My only real concern is that we reach a point that there will be (fewer) people trained to teach. Down the road, there will be (fewer) and (fewer) people available for that."
In a related study in the same issue of Annals, Coco reports that women actually receive more comprehensive care from family physicians, compared with obstetricians, during prenatal care visits. Coco studied 223 million visits to obstetricians and 21 million visits to family physicians and found that 17.6 percent of the visits with FPs included secondary and tertiary nonobstetric diagnoses compared with 7.8 percent of prenatal visits with obstetricians that included such additional diagnoses.
Share this on AAFP Connection
This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Clinical Care & Research