Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study
Objective We compared processes of antepartum, intrapartum and postpartum care and obstetrical outcomes between physicians and non-physicians.Design This is a population-based retrospective matched cohort study.Setting The study was conducted in Ontario, Canada.Participants Physicians and non-physic...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-12-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e091312.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850251143503937536 |
|---|---|
| author | Maria C Cusimano Andrea N Simpson Nancy N Baxter Rinku Sutradhar Eric McArthur |
| author_facet | Maria C Cusimano Andrea N Simpson Nancy N Baxter Rinku Sutradhar Eric McArthur |
| author_sort | Maria C Cusimano |
| collection | DOAJ |
| description | Objective We compared processes of antepartum, intrapartum and postpartum care and obstetrical outcomes between physicians and non-physicians.Design This is a population-based retrospective matched cohort study.Setting The study was conducted in Ontario, Canada.Participants Physicians and non-physicians residing in high-income urban areas from 1 April 2009 to 26 November 2018 were included. Physicians were matched to non-physicians on maternal age, calendar year, parity, conception by assisted reproductive technology and singleton versus multifetal gestation. We compared processes of antepartum, intrapartum and postpartum care between physicians and non-physicians.Outcome measures The primary outcome was mode of delivery (caesarean section, C-section vs vaginal delivery). Secondary outcomes included obstetrical anal sphincter injury among those experiencing vaginal birth and differences in urgent healthcare contacts (maternal and neonatal) during the postpartum period.Results 7327 physicians were matched 1:5 to 36 185 non-physicians and were well balanced except for comorbidities (physicians had fewer comorbidities). Physicians had more antenatal ultrasounds and invasive prenatal testing, received labour anaesthesia more often and were more often delivered by their own care provider. In adjusted analyses, physicians and non-physicians had a similar risk of C-section (aRR 0.97, 95% CI 0.93 to 1.00, p=0.07). There was no difference in neonatal urgent care contacts; non-physicians had a higher risk of maternal urgent postpartum care (adjusted relative risk [aRR] 1.22, 95% CI 1.08 to 1.37, p<0.0001).Conclusions Physicians and non-physicians of similar age and with similar pregnancy characteristics had a comparable rate of C-section, which may be related to a lack of cost drivers for C-section in Ontario. |
| format | Article |
| id | doaj-art-e0df5a8a7c64429082f20ba67d9041b3 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e0df5a8a7c64429082f20ba67d9041b32025-08-20T01:57:59ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-091312Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based studyMaria C Cusimano0Andrea N Simpson1Nancy N Baxter2Rinku Sutradhar3Eric McArthur45 Obstetrics & Gynaecology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA1 Department of Obstetrics & Gynaecology, St. Michael`s Hospital, Toronto, Ontario, Canada2 ICES, Toronto, Ontario, Canada2 ICES, Toronto, Ontario, Canada4 ICES Western, London, Ontario, CanadaObjective We compared processes of antepartum, intrapartum and postpartum care and obstetrical outcomes between physicians and non-physicians.Design This is a population-based retrospective matched cohort study.Setting The study was conducted in Ontario, Canada.Participants Physicians and non-physicians residing in high-income urban areas from 1 April 2009 to 26 November 2018 were included. Physicians were matched to non-physicians on maternal age, calendar year, parity, conception by assisted reproductive technology and singleton versus multifetal gestation. We compared processes of antepartum, intrapartum and postpartum care between physicians and non-physicians.Outcome measures The primary outcome was mode of delivery (caesarean section, C-section vs vaginal delivery). Secondary outcomes included obstetrical anal sphincter injury among those experiencing vaginal birth and differences in urgent healthcare contacts (maternal and neonatal) during the postpartum period.Results 7327 physicians were matched 1:5 to 36 185 non-physicians and were well balanced except for comorbidities (physicians had fewer comorbidities). Physicians had more antenatal ultrasounds and invasive prenatal testing, received labour anaesthesia more often and were more often delivered by their own care provider. In adjusted analyses, physicians and non-physicians had a similar risk of C-section (aRR 0.97, 95% CI 0.93 to 1.00, p=0.07). There was no difference in neonatal urgent care contacts; non-physicians had a higher risk of maternal urgent postpartum care (adjusted relative risk [aRR] 1.22, 95% CI 1.08 to 1.37, p<0.0001).Conclusions Physicians and non-physicians of similar age and with similar pregnancy characteristics had a comparable rate of C-section, which may be related to a lack of cost drivers for C-section in Ontario.https://bmjopen.bmj.com/content/14/12/e091312.full |
| spellingShingle | Maria C Cusimano Andrea N Simpson Nancy N Baxter Rinku Sutradhar Eric McArthur Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study BMJ Open |
| title | Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study |
| title_full | Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study |
| title_fullStr | Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study |
| title_full_unstemmed | Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study |
| title_short | Processes of obstetrical care and outcomes among Ontario physicians versus non-physicians: a population-based study |
| title_sort | processes of obstetrical care and outcomes among ontario physicians versus non physicians a population based study |
| url | https://bmjopen.bmj.com/content/14/12/e091312.full |
| work_keys_str_mv | AT mariaccusimano processesofobstetricalcareandoutcomesamongontariophysiciansversusnonphysiciansapopulationbasedstudy AT andreansimpson processesofobstetricalcareandoutcomesamongontariophysiciansversusnonphysiciansapopulationbasedstudy AT nancynbaxter processesofobstetricalcareandoutcomesamongontariophysiciansversusnonphysiciansapopulationbasedstudy AT rinkusutradhar processesofobstetricalcareandoutcomesamongontariophysiciansversusnonphysiciansapopulationbasedstudy AT ericmcarthur processesofobstetricalcareandoutcomesamongontariophysiciansversusnonphysiciansapopulationbasedstudy |