Declining trends in the provision of prenatal care visits by family physicians.
OBJECTIVE
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.
Cohen
Donna
D
The Lancaster General Research Institute, and the Department of Family and Community Medicine, Lancaster General Hospital, Lancaster, Pennsylvania 17604, USA. docohen@lancastergeneral.org
Coco
Andrew
A
D000328:Adult; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008423:Maternal Age; D008484:Medicaid; D008499:Medical Records; D009774:Obstetrics / Q000639:trends*; D010821:Physicians, Family / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends; D011247:Pregnancy; D011295:Prenatal Care / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D019035:Rural Health Services / Q000639:trends; D014481:United States; D019037:Urban Health Services / Q000639:trends; D055815:Young Adult