加拿大安大略省无证助产客户的结局：一项回顾性队列研究。

Outcomes of uninsured midwifery clients in Ontario, Canada: A retrospective cohort study.

机构信息

McMaster Midwifery Research Centre, McMaster University, HSC 4H24, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada.

Midwifery Education Program, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.

出版信息

Midwifery. 2019 Oct;77:24-31. doi: 10.1016/j.midw.2019.06.009. Epub 2019 Jun 19.

DOI:10.1016/j.midw.2019.06.009

PMID:31247482

Abstract

OBJECTIVE

To describe the characteristics, health service utilization, and clinical outcomes of Ontario residents who are not covered by the Ontario Health Insurance Plan and receive services from Ontario midwives.

DESIGN

Retrospective cohort study.

SETTING

Ontario, Canada.

PARTICIPANTS

All midwifery courses of care resulting in births between April 1, 2012 to March 31, 2015 and captured in the BORN perinatal registry. Within this cohort we compared midwifery clients without publicly funded health insurance to those covered by the Ontario Health Insurance Plan (OHIP).

MEASUREMENTS AND FINDINGS

Of 55, 634 midwifery clients assessed in Ontario, 92.8% were insured by OHIP and 7.2% were not insured. Among uninsured clients, 66.3% attended a prenatal visit during the first trimester compared to 92.8% of insured women, with uninsured clients presenting with fewer pre-existing conditions. A higher proportion of uninsured clients (33.9%) planned to birth at home and 28.7% of clients' actual place birth was in the home, compared to 19.6% and 16.6% of insured clients respectively. Rates of both spontaneous labour and spontaneous vaginal birth were higher among uninsured clients (82.1% and 81.1%, respectively), compared to insured clients (77.3% and 78.1%, respectively). Clinical outcomes were generally similar, with postpartum hemorrhage (3.4%), preterm birth (5%), and small-for-gestational age (2.1%) slightly more common among uninsured clients compared to insured clients (2.9%, 4.4%, and 1.7%, respectively). Rates of most complications were lower for uninsured clients.

KEY CONCLUSIONS

Overall, uninsured clients used less services compared to insured clients and had good clinical outcomes under midwifery care in Ontario. Findings of this study support the policy decision in Ontario to fund midwifery care for uninsured clients and suggest that uninsured clients are well suited for midwifery care.

IMPLICATIONS FOR PRACTICE

Funding midwives to serve uninsured clients is appropriate and may improve uninsured clients access to care.

摘要

目的

描述在安大略省，没有参加安大略省医疗保险计划（OHIP）却接受安大略省助产士服务的居民的特征、卫生服务利用情况和临床结局。

设计

回顾性队列研究。

地点

加拿大安大略省。

参与者

2012 年 4 月 1 日至 2015 年 3 月 31 日期间，所有在 BORN 围产期注册中心记录的助产护理课程中分娩的产妇。在这个队列中，我们将没有公共资助医疗保险的助产客户与参加 OHIP 的客户进行了比较。

测量和发现

在安大略省评估的 55634 名助产客户中，92.8%由 OHIP 承保，7.2%没有保险。在没有保险的客户中，66.3%在孕早期进行了产前检查，而参加保险的妇女则为 92.8%，而没有保险的客户则具有较少的先前存在的疾病。计划在家分娩的无保险客户比例较高（33.9%），实际在家分娩的客户比例为 28.7%，而参加保险的客户比例分别为 19.6%和 16.6%。无保险客户的自发性分娩（82.1%）和自然阴道分娩（81.1%）的比例均高于参加保险的客户（分别为 77.3%和 78.1%）。与参加保险的客户相比（分别为 2.9%、4.4%和 1.7%），无保险客户的产后出血（3.4%）、早产（5%）和小于胎龄儿（2.1%）略多。无保险客户的大多数并发症发生率较低。