Does prenatal care at community-based health centers result in infant primary care at these sites?
OBJECTIVE
To describe where women receiving prenatal care (PNC) at community-based health centers (CBHCs) go for infant primary care, and to assess reasons for and factors associated with leaving CBHCs and using other practices for infant care.


METHODS
A prospective survey of women receiving PNC at CBHCs from February 2000 to February 2002 was conducted. In-person, prepartum, and postpartum surveys included questions about sociodemographic and health characteristics, and health services use.


RESULTS
Among 1,107 primarily low-income, African American mothers, 60% of women left CBHCs and used other practices for their infants due to dissatisfaction, inconvenience, referral to and perceived expertise at other sites, and insurance changes. Leaving CBHCs was associated with being white, Latina, US born, educated beyond high school, single, owning a car, using non-CBHC practices for prepregnancy care, and having child health insurance. Among those who left, 48% used hospital-based clinics (HBCs) and 52% used private practices (PPs). Mothers using HBCs, when compared to those using PPs, were more likely to be African American (AOR = 6.83; 95% CI: 3.82, 12.22) or Latina (AOR = 5.60; 95% CI: 2.79, 11.24), dissatisfied with their PNC (AOR = 2.02; 95% CI: 1.05, 3.89) and to leave CBHCs because of insurance changes (AOR = 2.27; 95% CI: 1.18, 4.39) and perceived pediatric expertise at other sites (AOR = 4.81; 95% CI: 2.53, 9.11).


CONCLUSIONS
The majority of women in our study left CBHCs and used other sites for pediatric care. Higher education, having child health insurance, and car ownership were associated with leaving CBHCs. Among women who left, race/ethnicity and perceived pediatric expertise were major factors associated with using HBCs rather than PPs.
Chung
Esther K
EK
Division of General Pediatrics, Thomas Jefferson Medical College, Philadelphia, PA, USA. echung@nemours.org
McCollum
Kelly F
KF
Elo
Irma T
IT
Culhane
Jennifer F
JF
D000328:Adult; D003151:Community Health Centers; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007224:Infant Care; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care; D011320:Primary Health Care; D012959:Socioeconomic Factors