Mapping the Location of Health Centers in Relation to "Maternity Care Deserts": Associations With Utilization of Women's Health Providers and Services.
Adult
Ambulatory Care
/ statistics & numerical data
Community Health Centers
/ statistics & numerical data
Cross-Sectional Studies
Delivery, Obstetric
/ statistics & numerical data
Facilities and Services Utilization
/ statistics & numerical data
Female
Geography
Gynecology
/ statistics & numerical data
Health Care Surveys
Humans
Maternal Health Services
/ statistics & numerical data
Medically Underserved Area
Midwifery
/ statistics & numerical data
Nurse Practitioners
/ statistics & numerical data
Obstetrics
/ statistics & numerical data
Patient Acceptance of Health Care
/ statistics & numerical data
Physicians, Family
/ statistics & numerical data
Pregnancy
Prenatal Care
/ statistics & numerical data
United States
Women's Health
/ statistics & numerical data
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
entrez:
15
9
2021
pubmed:
16
9
2021
medline:
20
11
2021
Statut:
ppublish
Résumé
The aim was to explore the association between community health centers' (CHC) distance to a "maternity care desert" (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors. Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff. Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a "desert" were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234). Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to "deserts" had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care. CHCs located closer to "deserts" and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.
Sections du résumé
BACKGROUND AND OBJECTIVES
The aim was to explore the association between community health centers' (CHC) distance to a "maternity care desert" (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors.
MEASURES
Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff.
RESEARCH DESIGN
Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a "desert" were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234).
RESULTS
Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to "deserts" had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care.
CONCLUSIONS
CHCs located closer to "deserts" and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.
Identifiants
pubmed: 34524240
doi: 10.1097/MLR.0000000000001611
pii: 00005650-202110001-00007
pmc: PMC8428862
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
S434-S440Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Health Serv Res. 2002 Oct;37(5):1221-42
pubmed: 12479494
J Health Care Poor Underserved. 2008 May;19(2):625-38
pubmed: 18469432
J Perinatol. 2018 Jun;38(6):645-652
pubmed: 29453436
Health Aff (Millwood). 2017 Sep 1;36(9):1663-1671
pubmed: 28874496
Milbank Mem Fund Q Health Soc. 1973 Winter;51(1):95-124
pubmed: 4198894
AMIA Annu Symp Proc. 2018 Apr 16;2017:750-759
pubmed: 29854141
J Grad Med Educ. 2019 Oct;11(5):550-557
pubmed: 31636825
Hypertens Pregnancy. 2017 Feb;36(1):70-76
pubmed: 27835033
Fam Med Community Health. 2019 Jun 14;7(3):e000063
pubmed: 32148712
Popul Health Manag. 2013 Aug;16(4):270-5
pubmed: 23437869
Obstet Gynecol. 2012 Mar;119(3):611-6
pubmed: 22353960
Med Care. 1978 Jul;16(7):533-46
pubmed: 672266
Health Serv Res. 1974 Fall;9(3):208-20
pubmed: 4436074
Health Serv Res. 2013 Apr;48(2 Pt 1):455-75
pubmed: 22881056
J Fam Pract. 1991 Mar;32(3):295-9
pubmed: 2002321
Birth. 2014 Mar;41(1):26-32
pubmed: 24654634
Matern Child Health J. 2018 Jun;22(6):932-940
pubmed: 29411254
BMC Health Serv Res. 2007 Mar 09;7:40
pubmed: 17349050
JAMA. 2019 Jan 1;321(1):102-105
pubmed: 30620363
Health Serv Res. 2016 Aug;51(4):1546-60
pubmed: 26806952
Obstet Gynecol. 2012 May;119(5):1017-22
pubmed: 22525913
Health Serv Res. 1998 Aug;33(3 Pt 1):571-96
pubmed: 9685123
Health Aff (Millwood). 2017 Jan 1;36(1):49-56
pubmed: 28069846
Soc Work Health Care. 2011;50(9):682-93
pubmed: 21985110
J Am Board Fam Med. 2012 May-Jun;25(3):270-1
pubmed: 22570387
Health Serv Res. 1973 Fall;8(3):184-99
pubmed: 4593850