Division of Health Policy and Management, University of Minnesota School of PublicHealth, Minneapolis, MN55455, USA.
J Midwifery Womens Health. 2012 Sep-Oct;57(5):433-8. doi: 10.1111/j.1542-2011.2012.00171.x.
Health care needs of pregnant women are met by a variety of clinicians in a changing policy and practice environment. This study documents recent trends in types of clinicians providing care to pregnant women in the United States.
We used a repeat cross-sectional design and data from the Integrated Health Interview Series (2000-2009), a nationally representative data set, for respondents who reported being pregnant at the time of the survey (N = 3204). Using longitudinal logistic regression models, we analyzed changes over time in pregnant women's reported use of care from 1) obstetrician-gynecologists; 2) midwives, nurse practitioners (NPs), or physician assistants (PAs); or 3) both an obstetrician-gynecologist and a midwife, NP, or PA.
The percentage of pregnant women who reported seeing an obstetrician-gynecologist (87%) remained steady from 2000 through 2009. After controlling for demographic and clinical variables, the percentage who reported receiving care from a midwife, NP, or PA increased 4% annually (yearly adjusted odds ratio [AOR] 1.04; P < .001), indicating a cumulative increase of 48% over the decade. The percentage of pregnant women who received care from both an obstetrician-gynecologist and a midwife, NP, or PA also increased (AOR 1.027; P < .001), for a cumulative increase of 30%.
The increasing role of midwives, NPs, and PAs in the provision of maternity care suggests changes in the perinatal workforce and practice models that may promote collaborative care and quality improvement. However, better data collection is required to gather detailed information on specific provider types, these trends, and their implications.
在不断变化的政策和实践环境下，各种临床医生满足了孕妇的医疗需求。本研究记录了美国为孕妇提供护理的临床医生类型的最新趋势。
我们使用重复的横截面设计和综合健康访谈系列（2000-2009 年）的数据，这是一个全国代表性的数据集，用于调查时报告怀孕的受访者（N=3204）。我们使用纵向逻辑回归模型，分析了 2000 年至 2009 年期间孕妇报告的以下三种类型的护理使用情况的变化：1）妇产科医生；2）助产士、护士从业者（NPs）或医师助理（PAs）；3）妇产科医生和助产士、NPs 或 PAs。
报告看妇产科医生的孕妇比例（87%）从 2000 年到 2009 年保持稳定。在控制了人口统计学和临床变量后，报告接受助产士、NPs 或 PAs 护理的比例每年增加 4%（每年调整后的优势比[AOR]为 1.04；P<0.001），表明这十年间增加了 48%。报告同时接受妇产科医生和助产士、NPs 或 PAs 护理的孕妇比例也有所增加（AOR 1.027；P<0.001），增加了 30%。
助产士、NPs 和 PAs 在提供产妇护理方面的作用不断增加，这表明围产期劳动力和实践模式发生了变化，可能促进了协作护理和质量改进。然而，需要更好的数据收集来收集有关特定提供者类型、这些趋势及其影响的详细信息。
