1. Obstetric Patient Satisfaction and Retention in a Family Medicine Residency Keisa Bennett MD, MPH Sreevali Chamarthi MBBS Ashley Rollins BA

2. Acknowledgements Margaret Love, PhD, Research Director Joseph Allard, Department Administrator All of the maternity care patients who have journeyed with us through Family Medicine- based care in a University-based system Especially our survey respondents

3. The Local Situation Only 1 FM Attending delivering since 2007 Low prenatal patient volume High patient attrition Perception that patients referred to OB for any reason never came back to FM Unknown reputation of FM maternity care among patients

4. The National Situation Fewer FP’s are delivering babies and fewer women are being cared for or delivered by FP’s. Substantial evidence that FP’s provide good quality maternity care. Almost no studies of patient satisfaction with FM maternity providers, and none on causes of patient attrition.

5. Research Questions Why do patients come to UK Family Medicine for maternity care? Why do those who transfer away do so? Why do others choose to stay? What do patients value in the Family Medicine maternity care approach? What percentage of patients transfer to an obstetrician for medical reasons?

6. Methods Paper survey: quantitative & qualitative Sent to all patients with 2 or more visits coded to include antenatal care between January 2008 and December 2010 Non-respondents called; up to 3 attempts Thank-you or reminder postcards sent

7. Respondents 206 eligible 51 not able to be contacted by mail or phone Rate 24.9% 119 non-respondents Responses: 36 Response rate 23.2%

8. Demographics 69% age 30+ 67% white, 18% black, 15% other 12% Hispanic 69% 2 or fewer pregnancies; 80% 2 or fewer children 47% UK-HMO, 33% Medicaid, 14% private insurance

9. Results Who provided prenatal care? FP 61% OB 30% shared 3% didn’t know 6% Who delivered? FP 39% OB 45.5% didn’t know 15% Type of delivery: SVD 65% CS 21% assisted VD 15.2% 60% reported no prenatal problems; 58% reported no L&D complications

10. Results StatementLikert mean (1 to 5) Appropriate labs & referrals4.45 Clinic nurses friendly and helpful4.35 FP was patient with questions & reassurance4.29 I am satisfied with care received4.27 Continuity of provider3.77 Able to reach a doctor by phone3.76 Received counseling on breastfeeding3.72 I plan to come to an FP for any future pregnancy 3.70

11. Results: Associations Prenatal complications & type of delivery (0.039) Race & recommendation of FP (0.013)* Miscarriage & questions answered (0.021) Miscarriage & return to FP (0.007) Prenatal complications & satisfaction (0.006)

12. Results: Associations Delivery doctor & FP’s good at maternity care ( 0.017) Delivery doctor & questions answered ( 0.019) Delivery doctor & triage (0.012) Delivery doctor & continuity & satisfaction (0.002 & 0.039) PP complications & testing (0.002)

13. Conclusions Limitations Sample size, response bias No registry for prenatal patients Patients in this sample & time period were satisfied with FMC care overall. Threshold for referral or patient-initiated transfer to OB was low Communication & system navigation largest problem

14. Discussion Future work Focus groups; working groups Prenatal patient registry Larger-scale survey on patient needs Our new prenatal population How do we determine what patients value? How do we share and navigate across specialties?

15. Thank You