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Comparative Study
. 2009 Mar-Apr;7(2):128-33.
doi: 10.1370/afm.916.

Declining trends in the provision of prenatal care visits by family physicians

Donna Cohen  1 , Andrew Coco
Affiliations
Comparative Study

Declining trends in the provision of prenatal care visits by family physicians

Donna Cohen et al. Ann Fam Med. 2009 Mar-Apr.

Abstract

Purpose: We wanted to measure trends in the proportion of prenatal visits provided by family physicians nationally for a 10-year period and determine characteristics of prenatal visits made to family physicians compared with visits made to obstetricians.

Methods: We analyzed the National Ambulatory Medical Care Survey to identify prenatal visits made to family physicians and obstetricians between 1995 and 2004. The primary outcome measure was the trend in proportion of prenatal visits seen by family physicians. Multivariate logistic regression analysis determined characteristics of a prenatal visit occurring with a family physician vs an obstetrician.

Results: A total of 6,203 records were included in the study, representing 244 million prenatal visits. The percentage of prenatal visits provided by family physicians decreased from 11.6% in 1995-1996 to 6.1% in 2003-2004 (P=.02 for trend). In non-metropolitan statistical areas, family physicians decreased their provision of prenatal visits from 38.6% in 1995-1996 to 12.9% in 2003-2004 (P=.03 for trend). Prenatal visits made to family physicians were associated with location in a non-metropolitan statistical area (OR = 5.56; 95% CI, 3.23-9.62), Medicaid insurance (OR = 1.76; 95% CI, 1.10-2.82), and younger maternal age (aged 30 years and older vs aged less than 24 years: OR = 0.63; 95% CI, 0.41-0.95).

Conclusions: Family physicians reduced their provision of prenatal visits by nearly 50% during a 10-year period and at an even greater rate in rural, non-metropolitan statistical areas. These findings should be considered as family medicine considers the role of maternity care and strives to provide accessible prenatal services for all.

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Figures

Figure 1.
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.
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.
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