Evaluation of a novel model for rural obstetric care.

INTRODUCTION The group practice physicians in Marathon, a small rural community in northwestern Ontario, discovered general lifestyle dissatisfaction with the traditional model for obstetric practice. The old model of doing the follow-up and delivery for one's own patients created perceived onerous on-call responsibilities. The providers created a new model of obstetric care. This involved the local providers of obstetric care each taking 1 month of the year in rotation and following up any woman due in that month for prenatal and intrapartum services. This study is an investigation of patient and provider satisfaction with this model. METHODS Patient survey: We surveyed all 73 women who received obstetric care under the new model during its first 14 months of implementation. We collected data on patient demographics and patients' satisfaction with their obstetric experience using Likert scale, yes/no and short-answer questions. Physician survey: We surveyed the 9 physicians of Marathon Family Practice using Likert scale, yes/no and short-answer questions. We collected information on demographics, history of involvement with obstetric service, and comparison of old and new models with regard to patient care, and professional and personal issues. RESULTS Patient survey: The response rate was 56%. Of the respondents, 97% reported their expectations for their obstetric care were met, if not surpassed, and 100% were satisfied with their obstetric care. Physician survey: All the physicians responded and found the new model to cause less disruption of their family practice (Wilcoxon signed rank test, p = 0.041), to improve scheduling of personal activities (p = 0.017) and to improve their satisfaction with on-call hours (p = 0.027). Overall, the physicians were satisfied with the new model and preferred it to the old model. CONCLUSION This obstetric care model meets patients' expectations and provides patient satisfaction. It provides practitioners with an increased quality of life and greater satisfaction. It is a viable paradigm for the provision of obstetric care in the appropriate setting.