How often do physicians address other medical problems while providing prenatal care?
OBJECTIVE
It is unknown to what extent physicians address multiple problems while providing prenatal care. The objective of this study was to determine the percentage of prenatal encounters with 1 or more secondary and tertiary nonobstetric diagnoses and compare rates between family physicians and obstetricians.


METHODS
Using the National Ambulatory Medical Care Survey, 1995-2004, I analyzed prenatal visits to family physicians' and obstetricians' offices. The outcome measure was the percentage of prenatal encounters with 1 or more secondary and tertiary nonobstetric diagnoses seen by family physicians and obstetricians.


RESULTS
There were 6,203 visit records that met study criteria, representing 223 million visits to obstetricians and 21 million visits to family physicians. Of the prenatal encounters with a family physician, 17.6% (95% confidence interval [CI], 12.9%-22.4%) included 1 or more secondary and tertiary nonobstetric diagnoses compared with 7.8% (95% CI, 6.1%-9.6%) of prenatal encounters with an obstetrician (P <.01). After controlling for other variables, being seen by a family physician, compared with being seen by an obstetrician, remained an independent predictor of a prenatal visit with an additional nonobstetric diagnosis (OR = 2.57; 95% CI, 1.82-3.64).


CONCLUSIONS
Family physicians diagnose nonobstetric problems frequently and considerably more often than obstetricians while providing prenatal care. This practice style enhances access to comprehensive primary care for women.
Coco
Andrew
A
The Lancaster General Research Institute, and the Department of Family and Community Medicine, Lancaster General Hospital, Lancaster, Pennsylvania 17604, USA. docohen@lancastergeneral.org
D000328:Adult; D003191:Comprehensive Health Care / Q000379:methods*; D005194:Family Practice / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008499:Medical Records; D009774:Obstetrics / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult