David Johnson1, Yan Jin. 1. Departments of Medicine, Anesthesia, and Community Health and Epidemiology, University of Saskatchewan, Saskatoon. David.Johnson@gov.ab.ca
Abstract
OBJECTIVE: To compare the obstetric practices of family physicians who attended fewer than 25 births per year (low-volume) with the practices of family physicians who attended more than 25 births per year (high-volume) and the practices of obstetricians. DESIGN: Retrospective cohort study using data from administrative databases. SETTING: Alberta. PARTICIPANTS: All physicians who provided intrapartum care between April 1, 1997, and March 31, 2000. MAIN OUTCOME MEASURES: Type of delivery, size of hospitals where deliveries took place, characteristics of patients, and number of medical interventions. RESULTS: Of 1026 family physicians, 543 (53%) were low-volume providers of intrapartum care. In 1997-1998, low-volume family physicians (LVFPs) attended 24% of all vaginal and cesarean births attended by family physicians; by 1998-1999, that percentage had decreased to 9%; and by 1999-2000, to 5%. In contrast, the number of births attended by all family physicians remained relatively constant at 43% during the 3 years. In hospitals that had fewer than 50 deliveries a year, LVFPs attended almost half the births. Although LVFPs did fewer medical inductions, vacuum extractions, and epidural anesthetics and more forceps extractions, episiotomies, and cesarean sections than high-volume family physicians (HVFPs), the differences between their practices were much smaller than the differences between all family physicians' practices and the practices of obstetricians (who treat higher-risk mothers and newborns). CONCLUSION: The decrease in LVFPs' obstetric practices could make a pronounced difference at smaller hospitals where most low-volume practice occurs.
OBJECTIVE: To compare the obstetric practices of family physicians who attended fewer than 25 births per year (low-volume) with the practices of family physicians who attended more than 25 births per year (high-volume) and the practices of obstetricians. DESIGN: Retrospective cohort study using data from administrative databases. SETTING: Alberta. PARTICIPANTS: All physicians who provided intrapartum care between April 1, 1997, and March 31, 2000. MAIN OUTCOME MEASURES: Type of delivery, size of hospitals where deliveries took place, characteristics of patients, and number of medical interventions. RESULTS: Of 1026 family physicians, 543 (53%) were low-volume providers of intrapartum care. In 1997-1998, low-volume family physicians (LVFPs) attended 24% of all vaginal and cesarean births attended by family physicians; by 1998-1999, that percentage had decreased to 9%; and by 1999-2000, to 5%. In contrast, the number of births attended by all family physicians remained relatively constant at 43% during the 3 years. In hospitals that had fewer than 50 deliveries a year, LVFPs attended almost half the births. Although LVFPs did fewer medical inductions, vacuum extractions, and epidural anesthetics and more forceps extractions, episiotomies, and cesarean sections than high-volume family physicians (HVFPs), the differences between their practices were much smaller than the differences between all family physicians' practices and the practices of obstetricians (who treat higher-risk mothers and newborns). CONCLUSION: The decrease in LVFPs' obstetric practices could make a pronounced difference at smaller hospitals where most low-volume practice occurs.
Authors: L J Peddle; H Brown; J Buckley; W Dixon; J Kaye; M Muise; E Rees; W Woodhams; C Young Journal: Am J Obstet Gynecol Date: 1983-01-15 Impact factor: 8.661
Authors: M Simunovic; T To; N Baxter; A Balshem; E Ross; Z Cohen; R McLeod; P Engstrom; E Sigurdson Journal: J Gastrointest Surg Date: 2000 May-Jun Impact factor: 3.452