How often do physicians address other medical problems while providing prenatal care?

Abstract

PURPOSE: 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.