Xu Xiao, Siefert Kristine A, Jacobson Peter D, Lori Jody R, Gueorguieva Iana, Ransom Scott B
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA.
J Rural Health. 2009 Winter;25(1):33-42. doi: 10.1111/j.1748-0361.2009.00196.x.
It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis.
This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship.
Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care.
After adjusting for other factors that might influence a physician's decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians' likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly 4-fold higher likelihood of withdrawing obstetric care when compared with urban family physicians.
The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care.
长期以来，人们一直担心职业责任问题对农村地区妇女产科服务的提供产生了不成比例的影响。密歇根州有大量农村社区，被认为面临医疗责任危机的风险。
本研究调查产科医疗服务提供者面临的更高医疗事故负担是否与停止产科护理的可能性增加相关，以及这种关系在城乡之间是否存在差异。
从密歇根州的一项全州范围调查中获取了500名在其职业生涯中（目前或以前）曾提供过产科护理的妇产科医生和家庭医生的数据。进行了统计检验和多变量回归分析，以研究医疗事故负担、农村地区位置和停止产科护理之间的相互关系。
在对可能影响医生是否停止产科护理决定的其他因素进行调整后，我们的结果显示医疗事故负担对医生停止产科护理的可能性没有显著影响。执业地点的城乡差异并未改变这种关系的性质。然而，与城市家庭医生相比，密歇根州农村地区的家庭医生停止产科护理的可能性高出近4倍。
在未来为维持产科护理供应而采取的干预措施中，应仔细权衡农村家庭医生停止产科护理可能性较高这一因素。需要进行更多研究，以更好地了解农村家庭医生的执业环境及其停止产科护理的原因。
