Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes
نویسندگان
چکیده
BACKGROUND In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. METHODS DESIGN Observational population-based study. SETTING Reggio Emilia Province. POPULATION 5957 women resident in the province who delivered between October 2010 and November 2011. MAIN OUTCOME MEASURES CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. RESULTS Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. CONCLUSIONS The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.
منابع مشابه
INVESTIGATING THE QUALITY AND ADEQUACY OF PRE-PREGNANCY CARE FROM THE POINT OF VIEW OF WOMEN REFERRING TO URMIA CITY HOSPITALS IN 2021
Background & Aim: One of the programs of the health system in Iran is providing services related to pregnancy, which is provided in three areas of pre-pregnancy, pregnancy, and postpartum care. Quality and quantity assessment shows how health care programs are implemented and identifies the inadequacies of the programs to solve the main problems. Therefore, the present study was conducted to in...
متن کاملمقایسه مراکز بهداشتی درمانی دولتی و تعاونی از نظر دستاوردهای ارائه خدمات و مراقبتهای اولیه سلامتی
Background and Aim: Public-private partnership is a type of privatization in which the public sector continues to participate in the provision of services. Based on an agreement between the Ministry of Health and the Ministry of Cooperatives, Tabriz University of Medical Sciences started the process of creating health cooperatives in the Eastern Azerbaijan Province. In this study we compare the...
متن کاملنظریَه ی مدیریَت نوین دولتی و نقش آن در کارایی ارائه ی خدمات بهداشتی و درمانی در ایران
Introduction: The pattern of health services delivery across the world changes from a spectrum of pure public to pure private sector. The failure of pure private sector, as well as pure public sector, brought experts to recommend alternative approaches such as New Public Management theory as a third-way. This article was aimed to present the results of reform in East Azerbaijan Province on the ...
متن کاملTHE STUDY OF RELATIONSHIP BETWEEN CHILDBIRTH SELF-EFFICACY AND ATTITUDE TOWARD NORMAL DELIVERY WITH PREGNANCY ANXIETY IN PRIMIGRAVIDA WOMEN REFERRED TO SELECTED HEALTH CARE CENTERS OF SHAHRIAR CITY IN 2018
Background & Aims: Anxiety is one of the psychological problems of pregnant mothers. That is a powerful factor in predicting negative outcomes during childbirth. Women with low self-efficacy in childbirth are afraid that they will not be able to cope well with the pain of childbirth. Therefore, self-efficacy can play an important role in choosing the type of delivery. On the other hand, misconc...
متن کاملComparison of Pregnancy Self-Care, Perceived Social Support and Perceived Stress in Low-risk and High-risk Groups
Background & objectives: Although, pregnancy and delivery are natural processes in woman's life, they are stressful experiences with emotional, physical and social changes. Woman’s response to pregnancy is affected by a variety of factors, among which pregnancy age can be considered as the most important factor with significant effects on pregnancy and delivery processes. This study was conduct...
متن کامل