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. 2019 Dec;65(12):901-909.

Is attending birth dying out? Trends in obstetric care provision among primary care physicians in British Columbia

Lindsay Hedden  1 , Sarah Munro  2 , Kimberlyn M McGrail  3 , Michael R Law  4 , Ivy L Bourgeault  5 , Morris L Barer  6
Affiliations

Is attending birth dying out? Trends in obstetric care provision among primary care physicians in British Columbia

Lindsay Hedden et al. Can Fam Physician. 2019 Dec.

Abstract
in English, French

Objective: To examine trends in and sociodemographic predictors of the provision of obstetric care within the primary care context among physicians in British Columbia (BC).

Design: Population-based, longitudinal cohort study using administrative data.

Setting: British Columbia.

Participants: All primary care physicians practising in BC between 2005-2006 and 2011-2012.

Main outcome measures: Fee-for-service payment records were used to identify the provision of prenatal and postnatal care and deliveries. The proportions of physicians who attended deliveries and who included any obstetric care provision in their practices were examined over time using longitudinal mixed-effects log-linear models.

Results: The proportion of physicians attending deliveries or providing any obstetric care declined significantly over the study period (deliveries: odds ratio [OR] of 0.92, 95% CI 0.89-0.95; obstetric care: OR = 0.92, 95% CI 0.89-0.95), and obstetric care provision accounted for a smaller proportion of overall practice activity (OR = 0.96, 95% CI 0.94-0.99). Female physicians had higher odds of including obstetric care in their practices (OR = 1.46, 95% CI 1.27-1.69), and by 2011-2012 had significantly higher odds of attending deliveries (OR = 1.22, 95% CI 1.05-1.38). Older physicians and those located in metropolitan centres were less likely to provide obstetric care or attend deliveries.

Conclusion: The provision of obstetric care by primary care physicians in BC declined over this period, suggesting the possibility of a growing access issue, particularly in rural and remote communities where family physicians are often the sole providers of obstetric services.

Objectif: Examiner les tendances et les indices démographiques dans la prestation des soins obstétriques dans le contexte des soins primaires chez les médecins en Colombie-Britannique (C.-B.).

Type d’étude: Étude de cohorte longitudinale populationnelle, à l’aide de données administratives.

Contexte: Colombie-Britannique.

Participants: Tous les médecins de soins primaires en pratique active en C.-B. entre 2005–2006 et 2011–2012.

Principaux paramètres à l’étude: Les dossiers de rémunération à l’acte ont servi à cerner la prestation des soins prénatals et postnatals, de même que les accouchements. Les proportions de médecins qui assistaient aux accouchements et qui incluaient la prestation de soins obstétriques, quels qu’ils soient, ont été mesurées au fil des ans à l’aide de modèles log-linéaires longitudinaux à effets mixtes.

Résultats: La proportion de médecins qui procédaient aux accouchements ou offraient des soins obstétriques a baissé de manière significative durant la période à l’étude (accouchements : rapport de cotes [RC] de 0,92, IC à 95 % de 0,89 à 0,95; soins obstétriques : RC = 0,92, IC à 95 % de 0,89 à 0,95), et la prestation des soins obstétriques représentait une proportion plus faible des activités de la pratique dans son ensemble (RC = 0,96, IC à 95 % de 0,94 à 0,99). La possibilité que les femmes médecins incluent les soins obstétriques dans leur pratique était plus élevée (RC = 1,46, IC à 95 % de 1,27 à 1,69), et en 2011–2012, la possibilité de procéder aux accouchements était significativement plus grande (RC = 1,22, IC à 95 % de 1,05 à 1,38). Il était moins probable que les médecins plus âgés et ceux situés dans les centres métropolitains offrent des soins obstétriques ou fassent des accouchements.

Conclusion: La prestation des soins obstétriques par les médecins de soins primaires en C.-B. a connu un déclin au cours de la période étudiée, ce qui laisse présager la possibilité de problèmes d’accès grandissants, surtout dans les collectivités rurales et éloignées où les médecins de famille sont souvent les seuls prestataires de services obstétriques.

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Figures

Figure 2.
Figure 2.
Adjusted proportion of physicians’ billing activity that is classified as obstetric care provision, by study year
Figure 1.
Figure 1.
Adjusted proportion of physicians who billed for 1 or more deliveries and any obstetric care, by study year
See this image and copyright information in PMC

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