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Low-volume obstetrics. Characteristics of family physicians' practices in Alberta
1Departments of Medicine, Anesthesia, and Community Health and Epidemiology, University of Saskatchewan, Saskatoon. David.Johnson@gov.ab.ca
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.