obstetrics, family medicine, residency, quality improvement, prenatal care, clinic
Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care.
Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB.
Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide OB care, through fliers at emergency departments/urgent cares or posters in clinic waiting rooms; 2) keeping at least one same-day visit for OB patients; 3) distributing standard OB note templates to residents/faculty; and 4) placing patient educational handouts at each clinic. Patients, residents and faculty were reassessed at 9 months postintervention. Surveys were analyzed with Fisher’s exact tests.
Results: Respondents to the preintervention survey included 83 patients, 26 residents and 19 faculty; 61 patients, 23 residents and 21 faculty responded to the postintervention survey. On both pre- and post-surveys, patients knew that their providers delivered babies (59% vs 57%, respectively; P = 0.86). However, only 22% and 33% of patients, respectively, had a doctor at our clinics deliver their baby or partner’s baby (P = 0.25). Even so, 95% and 100% of patients, respectively, would recommend their friends or family to our family practice clinics if they became pregnant (P = 0.14). On the pre-survey, 38% of residents felt clinic OB numbers were adequate versus 70% following intervention (P < 0.05). On both pre- and post-surveys, residents planned on incorporating obstetric or prenatal care into their future practice (42% vs 52%, respectively; P = 0.57). On both pre- and post-surveys, faculty felt comfortable with OB skills and knowledge (53% vs 62%, respectively; P = 0.75). Lifestyle was the most common reason faculty gave for why they stopped doing deliveries (37% vs 33%, respectively).
Conclusion: Implementation of changes to our OB workflow resulted in non-statistically significant improvements in viewpoints toward OB. Resident feelings of OB number adequacy significantly improved following intervention. Further study in multiple clinics could confirm the effectiveness and reasons for success of our interventions.
Chawla G, Kram JJ, Bobot B, Baumgardner DJ. Improving obstetrics in family medicine residency clinics: a quality improvement study. J Patient Cent Res Rev. 2017;4:260-1.