Is outcome for general practitioner obstetricians influenced by workload and locality?

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• General practitioner obstetricians (GPOs) play a vital role in maternal care.
• Understanding factors influencing transfer patterns and outcomes is crucial for optimizing obstetric care delivery.
• Geographic location (urban vs. rural) and practice volume may impact GPO decision-making and patient outcomes.

Purpose of the Study:

• To examine the influence of GPO delivery volume and proximity to specialist care on maternal and perinatal morbidity and transfer patterns.
• To compare transfer rates and obstetric risk profiles between urban and rural GPOs.
• To assess the association between GPO delivery numbers and maternal/neonatal morbidity.

Main Methods:

• Retrospective analysis of maternal and perinatal morbidity and transfer data.
• Comparison of transfer patterns based on GPO practice location (urban/rural) and annual delivery volume (<20 vs. >=20).
• Assessment of obstetric risk stratification and maternal/neonatal outcomes.

Main Results:

• Significant differences in transfer patterns were observed between urban and rural GPOs, and between low- (<20/year) and high-volume (>=20/year) practitioners.
• Rural GPOs transferred more patients antenatally; lower-volume practitioners had higher antenatal transfer rates.
• Urban GPOs managed a higher proportion of high-risk pregnancies, and urban practices had a higher rate of unfavorable maternal/neonatal outcomes compared to rural practices. No direct association was found between GPO delivery volume and maternal/neonatal morbidity.

Conclusions:

• GPO practice characteristics, including location and delivery volume, significantly influence obstetric transfer patterns.
• While GPO volume did not directly correlate with maternal/neonatal morbidity, urban GPOs managed higher-risk patients and experienced more unfavorable outcomes.
• Optimizing obstetric care may require tailored support and resource allocation based on GPO practice setting and volume.