Farrow D C, Baldwin L M, Cawthon M L, Connell F A
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle 98195, USA.
Am J Prev Med. 1996 Mar-Apr;12(2):103-7.
The goals of this study were to examine the use of maternity support services (MSS) and maternity case management (MCM) by Medicaid-eligible low-income pregnant women in Washington state, and to determine whether receipt of the services was associated with improved prenatal care use. We obtained data from linked birth certificates and Medicaid eligibility and claims files for women delivering between August 1989 and December 1991. Unconditional logistic regression was used to assess the programs' effects independent of other variables associated with prenatal care adequacy. The percentage of women receiving MSS and MCM was highest among women with demographic risks for adverse birth outcomes. Women receiving prenatal care from health departments or community clinics were more likely to receive MSS and MCM than those seen by private physicians or midwives. After adjustment for multiple confounding factors, we found that recipients of MSS, but not MCM, were significantly less likely than other women to receive an inadequate number of prenatal visits. Our findings suggest that public policies that pay for support services to low-income pregnant women can improve the use of prenatal care.
本研究的目的是调查华盛顿州符合医疗补助条件的低收入孕妇对孕产妇支持服务（MSS）和孕产妇病例管理（MCM）的使用情况，并确定接受这些服务是否与产前护理利用率的提高相关。我们从1989年8月至1991年12月分娩的妇女的关联出生证明、医疗补助资格和索赔档案中获取了数据。使用无条件逻辑回归来评估这些项目的效果，独立于与产前护理充足性相关的其他变量。在有不良出生结局人口统计学风险的妇女中，接受MSS和MCM的妇女比例最高。与由私人医生或助产士诊治的妇女相比，从卫生部门或社区诊所接受产前护理的妇女更有可能接受MSS和MCM。在对多个混杂因素进行调整后，我们发现接受MSS但未接受MCM的妇女比其他妇女接受产前检查次数不足的可能性显著更低。我们的研究结果表明，为低收入孕妇的支持服务付费的公共政策可以提高产前护理的利用率。
