Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada; ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.
ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, 1001 Queen St W, Toronto, Ontario, M6J 1H4, Canada.
Disabil Health J. 2022 Jul;15(3):101322. doi: 10.1016/j.dhjo.2022.101322. Epub 2022 Mar 26.
Women with disabilities experience elevated risks for pregnancy complications and report barriers accessing prenatal care. Emerging evidence highlights the significant role primary care providers play in promoting preventive services like prenatal care.
To examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities.
We conducted a population-based study using health administrative data in Ontario, Canada. The study population included 15- to 49-year-old women with physical (n = 106,555), sensory (n = 32,194), intellectual/developmental (n = 1515), and multiple (n = 6543) disabilities who had a singleton livebirth or stillbirth in 2003-2017 and ≥ 3 primary care visits < 2 years before conception. COC was measured using the Usual Provider of Care Index. Nominal logistic regression was used to compute adjusted odds ratios (aOR) for prenatal care adequacy, measured using the Revised-Graduated Prenatal Care Utilization Index, for women with low versus moderate/high COC, controlling for other social and medical characteristics.
Women with disabilities with low COC, versus those with moderate/high COC, had increased odds of no (aOR 1.42, 95% CI 1.29-1.56), inadequate (aOR 1.19, 95% CI 1.16-1.23), and intensive prenatal care (aOR 1.22, 95% CI 1.19-1.25) versus adequate. In additional analyses, women with low COC and no/inadequate prenatal care were the most socially disadvantaged among the cohort, and those with low COC and intensive prenatal care had the greatest medical need.
Improving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access.
残疾女性在妊娠并发症方面的风险较高，并报告在获得产前保健方面存在障碍。新出现的证据强调了初级保健提供者在促进产前保健等预防服务方面的重要作用。
检查残疾女性中初级保健连续性（COC）与产前保健充足性之间的关系。
我们在加拿大安大略省使用健康管理数据进行了一项基于人群的研究。研究人群包括在 2003-2017 年期间有过单胎活产或死产且<2 年前有≥3 次初级保健就诊的 15-49 岁女性，她们患有身体残疾（n=106555）、感觉残疾（n=32194）、智力/发育残疾（n=1515）和多重残疾（n=6543）。使用常规提供者护理指数来衡量 COC。使用修订后的分级产前保健利用指数来衡量产前保健充足性，并使用名义逻辑回归计算 COC 低与中/高的调整比值比（aOR），以控制其他社会和医疗特征。
与中/高 COC 的女性相比，COC 低的残疾女性获得无（aOR 1.42，95%CI 1.29-1.56）、不足（aOR 1.19，95%CI 1.16-1.23）和强化产前保健（aOR 1.22，95%CI 1.19-1.25）的可能性增加。在额外的分析中，COC 低且无/不足的产前保健女性是队列中社会最不利的人群，而 COC 低且强化产前保健的女性医疗需求最大。
改善残疾女性的初级保健获取，特别是那些处于社会劣势的女性，可能会导致更好的产前保健获取。
