D J Boss1, R E Timbrook. 1. Family Practice Residency, Fort Wayne Medical Education Program, IN 46805, USA.
Abstract
BACKGROUND: Continuity of care has long been considered a benefit to patients of family physicians, but quantifying these benefits has been problematic. Previous studies focused on patient preferences and relationship issues, whereas evidence regarding clinical endpoints has been lacking. This study reports differences in obstetric and neonatal outcomes related to continuity in prenatal care. METHODS: Using an historical prospective design, data were collected on 494 maternal-fetal dyads in two groups. One (named GAP, n = 40) received a high degree of continuity in their prenatal care, and one (named NHC, n = 454) received relatively little. Analyses were performed to determine not only the outcome differences between the groups, but also to what factor(s) these differences were attributable. RESULTS: The continuity in prenatal care group had better outcomes in neonatal morbidity, birth weight, maternal weight gain, and both Apgar scores. None of these differences was directly attributable to continuity. Rather, continuity in prenatal care was associated with the observed increase in the number of prenatal visits, which in turn was shown to be a significant factor in the greater birth weights and maternal weight gain. None of the factors examined appears to explain the difference in neonatal morbidity. CONCLUSIONS: Women who receive prenatal care from a single physician are likely to receive more prenatal care, which is correlated with greater maternal weight gains and greater fetal birth weights.
BACKGROUND: Continuity of care has long been considered a benefit to patients of family physicians, but quantifying these benefits has been problematic. Previous studies focused on patient preferences and relationship issues, whereas evidence regarding clinical endpoints has been lacking. This study reports differences in obstetric and neonatal outcomes related to continuity in prenatal care. METHODS: Using an historical prospective design, data were collected on 494 maternal-fetal dyads in two groups. One (named GAP, n = 40) received a high degree of continuity in their prenatal care, and one (named NHC, n = 454) received relatively little. Analyses were performed to determine not only the outcome differences between the groups, but also to what factor(s) these differences were attributable. RESULTS: The continuity in prenatal care group had better outcomes in neonatal morbidity, birth weight, maternal weight gain, and both Apgar scores. None of these differences was directly attributable to continuity. Rather, continuity in prenatal care was associated with the observed increase in the number of prenatal visits, which in turn was shown to be a significant factor in the greater birth weights and maternal weight gain. None of the factors examined appears to explain the difference in neonatal morbidity. CONCLUSIONS:Women who receive prenatal care from a single physician are likely to receive more prenatal care, which is correlated with greater maternal weight gains and greater fetal birth weights.