Bridging the Gaps in Obstetric Care: Perspectives of Service Delivery Providers on Challenges and Core Components of Care in Rural Georgia
| Autor: | Bridget Spelke, Meredith Pinto, Monique Hennink, Adrienne D. Zertuche, Roger W. Rochat |
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| Rok vydání: | 2016 |
| Předmět: |
Rural Population
medicine.medical_specialty Georgia Epidemiology Service delivery framework Attitude of Health Personnel Prenatal care Midwifery Health Services Accessibility Interviews as Topic 03 medical and health sciences 0302 clinical medicine Nursing Pregnancy medicine Humans Maternal Health Services 030212 general & internal medicine Healthcare Disparities Reimbursement Qualitative Research Service (business) 030219 obstetrics & reproductive medicine business.industry Public health Public Health Environmental and Occupational Health Obstetrics and Gynecology Prenatal Care Obstetrics Family medicine Pediatrics Perinatology and Child Health Workforce Female Rural Health Services business Medicaid Qualitative research |
| Zdroj: | Maternal and child health journal. 20(7) |
| ISSN: | 1573-6628 |
| Popis: | Objectives In 2011, a workforce assessment conducted by the Georgia Maternal and Infant Health Research Group found that 52 % of Primary Care Service Areas outside metropolitan Atlanta, Georgia, had an overburdened or complete lack of obstetric care services. In response to that finding, this study’s aim was twofold: to describe challenges faced by providers who currently deliver or formerly delivered obstetric care in these areas, and to identify essential core components that can be integrated into alternative models of care in order to alleviate the burden placed on the remaining obstetric providers. Methods We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and maternal and infant health leaders in Georgia. Interviews were digitally recorded, transcribed verbatim, uploaded into MAXQDA software, and analyzed using a Grounded Theory Approach. Results Providers faced significant financial barriers in service delivery, including low Medicaid reimbursement, high proportions of self-pay patients, and high cost of medical malpractice insurance. Further challenges in provision of obstetric care in this region were related to patient’s late initiation of prenatal care and lacking collaboration between obstetric providers. Essential components of effective models of care included continuity, efficient use of resources, and risk-appropriate services. Conclusion Our analysis revealed core components of improved models of care that are more cost effective and would expand coverage. These components include closer collaboration among stakeholder populations, decentralization of services with effective use of each type of clinical provider, improved continuity of care, and system-wide changes to increase Medicaid benefits. |
| Databáze: | OpenAIRE |
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