The outcomes of perinatal surgical services in rural British Columbia: a population-based study
Stefan Grzybowski1, Kathrin Stoll, Jude Kornelsen
1Centre for Rural Health Research; Vancouver Coastal Health Research Institute; Department of Family Practice, University of British Columbia, Vancouver, BC.
Introduction:
A substantial number of small surgical services in rural Canada have been discontinued in the past 15 years because of difficulties recruiting and retaining practitioners, health care restructuring and a lack of a coherent evidence base regarding the safety of small services. The objective of this study was to examine the safety of small perinatal surgical services.
Methods:
We accessed perinatal data for singleton births that occurred in British Columbia between Apr. 1, 2000, and Mar. 31, 2007. We defined hospital service levels, population catchment areas surrounding each hospital and the postal codes linked to those catchment areas. Births were linked with specific catchment areas and amalgamated by service level. We made comparisons among service strata populations and adjusted for potentially confounding characteristics.
Results:
A total of 87 294 births occurred during the study period. The births were distributed across 6 strata of services, which ranged from no local maternity services to services supported by obstetricians. Fifteen catchment areas were served by general practitioners with enhanced surgical skills (GPESSs), and 9174 births were included from this obstetric service level. Outcomes for surgical services provided by GPs compared favourably to those provided by obstetricians.
Conclusion:
Our results suggest that small surgical services supported by GPESSs are a safe health services model to meet the needs of rural women and families.
