From the Departments of Family, Internal, and Rural Medicine (JP, CS, DL) and Community Medicine and Population Health (DA, JL), University of Alabama College of Community Health Sciences, Tuscaloosa, AL.
J Am Board Fam Med. 2018 Jul-Aug;31(4):542-549. doi: 10.3122/jabfm.2018.04.170376.
The closure of obstetrics (OB) units at rural hospitals is thought to have implications for access to prenatal care (PNC) and infant mortality rate (IMR). The objective of this study was to determine whether local availability of PNC and OB services, specifically as provided by family physicians (FPs), would be associated with a lower IMR in 1 rural Alabama county.
Data from 1986 to 2013 from Pickens County was compared with data from 2 sets of control counties: Clarke/Monroe (full OB care) and Coosa/Conecuh (no local OB care).
From 1986 to 1991 (no local OB services; period 1), Pickens County's IMR was 17.9, which fell to 7.2 from 1993 to 2001 (with local services; period 2). After the county's OB unit closed, IMR rose to 16.0 from 2005 to 2013 (period 3). In Clarke/Monroe (continuous OB service), the IMR fell from 14.5 to 9.9 from period 1 to period 3. Coosa/Conecuh (no OB service) exhibited a consistent IMR ranging from 10.9 to 14.4.
OB services provided by FPs in Pickens County resulted in improvement of the county's IMR. Local PNC was associated with a lower IMR.
农村医院妇产科的关闭被认为对产前护理（PNC）和婴儿死亡率（IMR）的获得有影响。本研究的目的是确定在阿拉巴马州的一个农村县，当地的 PNC 和 OB 服务（特别是家庭医生提供的服务）是否与较低的 IMR 相关。
将皮肯斯县（Pickens County） 1986 年至 2013 年的数据与来自两组对照县的数据进行比较：克拉克/门罗县（完整的 OB 护理）和库萨/康纳彻县（无当地 OB 护理）。
从 1986 年到 1991 年（无当地 OB 服务；时期 1），皮肯斯县的 IMR 为 17.9，从 1993 年到 2001 年（有当地服务；时期 2）下降到 7.2。该县的 OB 部门关闭后，从 2005 年到 2013 年 IMR 上升至 16.0（时期 3）。在克拉克/门罗县（连续的 OB 服务），IMR 从时期 1 下降到时期 3 的 14.5 到 9.9。库萨/康纳彻县（无 OB 服务）表现出一致的 IMR，范围从 10.9 到 14.4。
皮肯斯县的家庭医生提供的 OB 服务导致了该县 IMR 的改善。当地的 PNC 与较低的 IMR 相关。
