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Research ArticleOriginal Research

Social Inequities Between Prenatal Patients in Family Medicine and Obstetrics and Gynecology with Similar Outcomes

Michael Partin, Ana Sanchez, Jessica Poulson, Arthur Berg, Jessica Parascando and Sarah Ines Ramirez
The Journal of the American Board of Family Medicine January 2021, 34 (1) 181-188; DOI: https://doi.org/10.3122/jabfm.2021.01.200279
Michael Partin
From the Department of Family and Community Medicine, College of Medicine, Penn State Hershey, PA (MP, JP, SIR); Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA (AS); College of Medicine, Penn State, Hershey, PA (JP); Department of Public Health Sciences, College of Medicine, Penn State, Hershey, PA (AB).
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Ana Sanchez
From the Department of Family and Community Medicine, College of Medicine, Penn State Hershey, PA (MP, JP, SIR); Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA (AS); College of Medicine, Penn State, Hershey, PA (JP); Department of Public Health Sciences, College of Medicine, Penn State, Hershey, PA (AB).
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Jessica Poulson
From the Department of Family and Community Medicine, College of Medicine, Penn State Hershey, PA (MP, JP, SIR); Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA (AS); College of Medicine, Penn State, Hershey, PA (JP); Department of Public Health Sciences, College of Medicine, Penn State, Hershey, PA (AB).
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Arthur Berg
From the Department of Family and Community Medicine, College of Medicine, Penn State Hershey, PA (MP, JP, SIR); Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA (AS); College of Medicine, Penn State, Hershey, PA (JP); Department of Public Health Sciences, College of Medicine, Penn State, Hershey, PA (AB).
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Jessica Parascando
From the Department of Family and Community Medicine, College of Medicine, Penn State Hershey, PA (MP, JP, SIR); Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA (AS); College of Medicine, Penn State, Hershey, PA (JP); Department of Public Health Sciences, College of Medicine, Penn State, Hershey, PA (AB).
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Sarah Ines Ramirez
From the Department of Family and Community Medicine, College of Medicine, Penn State Hershey, PA (MP, JP, SIR); Department of Family Medicine, Penn Medicine, Lancaster General Health, Lancaster, PA (AS); College of Medicine, Penn State, Hershey, PA (JP); Department of Public Health Sciences, College of Medicine, Penn State, Hershey, PA (AB).
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Article Figures & Data

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    Figure 1.

    Study population flow diagram. Abbreviations: FM, Family Medicine; OB/Gyn, Obstetrics and Gynecology; ICD, International Classification of Diseases.

  • Figure 2.
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    Figure 2.

    Social determinants of health between FM and OB/Gyn for PNC patients. Abbreviations: FM, Family Medicine; OB/Gyn, Obstetrics and Gynecology; PNC, Prenatal Care.

Tables

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    Table 1.

    Characteristics of Prenatal Patients Cared for by FM or OB/Gyn between January 2015 and December 2018

    OverallFamily MedicineObstetrics and GynecologyP Value
    Overall, No. (%)430 (100.0)215 (50.0)215 (50.0)—
    Age, year, mean (SD)27.7 (5.68)26.6 (5.7)28.6 (5.6)< .01
    Race, No. (%)215 (50.0)215 (50.0)
     Asian8 (1.9)3 (1.4)5 (2.3).48
     African American79 (18.4)61 (28.4)18 (8.4)< .01
     White265 (61.6)110 (51.2)155 (72.1)< .01
     Other66 (15.3)32 (14.9)34 (15.8).83
    Education, No. (%)215 (50.0)215 (50.0)
     Grade school20 (4.7)5 (2.3)15 (7.0)< .05
     High school139 (32.3)74 (34.4)65 (30.2).35
     GED6 (1.4)2 (0.9)4 (1.9)1.00
     Trade school14 (3.3)5 (2.3)9 (4.2).26
     College78 (18.1)28 (13.0)50 (23.3)< .01
     Postgraduate34 (7.9)7 (3.3)27 (12.6)< .01
     Unknown141 (32.8)94 (43.7)47 (21.9)< .01
    Employment, No. (%)215 (50.0)215 (50.0)
     Employed283 (65.8)131 (61.0)152 (70.7)< .05
     Unemployed89 (20.7)39 (18.1)50 (23.3).19
     Unknown58 (13.5)45 (20.9)13 (6.0)< .01
    Unemployed stratified, No. (%)88 (100.0)38 (43.2)50 (56.8)
     Homemaker38 (43.2)18 (47.3)20 (40.0).49
     Student22 (0.3)13 (34.2)9 (18.0).08
     Disabled1 (1.1)0 (0.0)1 (2.0).38
     Unemployed27 (30.7)7 (18.4)20 (40.0)< .05
    Insurance type, No. (%)215 (50.0)215 (50.0)
     BlueCross74 (17.2)28 (13.0)46 (21.4)< .05
     BlueShield86 (20.0)36 (16.7)50 (23.3)< .05
     Commercial58 (13.5)20 (9.3)38 (17.7)< .01
     Government programs13 (3.0)7 (3.3)6 (2.8).39
     HMO15 (3.5)7 (3.3)8 (3.7).40
     Medicaid149 (34.7)99 (46.0)50 (23.3)< .01
     Medicare4 (0.9)3 (1.4)1 (0.5).16
     Self pay20 (4.7)12 (5.6)8 (3.7).18
     PPO5 (1.2)0 (0.0)5 (2.3)< .05
     Unknown6 (1.4)3 (1.4)3 (1.4).50
    • GED, General Educational Development; HMO, Health Maintenance Organization; PPO, Preferred Provider Organization; FM, Family Medicine; OB/Gyn, Obstetrics and Gynecology.

    • View popup
    Table 2.

    PNC and Delivery Outcomes of FM and OB/Gyn Cohorts

    Family MedicineObstetrics and GynecologyP Value
    Overall, No. (%)215 (50.0)215 (50.0)—
    Gravidity, mean (SD)2.57 (1.7)2.43 (1.7).18
    Mode of delivery, No (%)
     pCS28 (13.0)41 (19.1).09
     rCS21 (9.8)27 (12.6).36
     Cesarean section total49 (22.8)68 (31.6)< .05
     SVD120 (55.8)122 (56.7).85
    Birth weight, g, mean (SD)3220 (618)3356 (545)< .05
    Gestational age at delivery, weeks, mean (SD)38.4 (2.7)38.7 (1.7).21
    Tobacco use during pregnancy, No. (%)36 (16.7)18 (8.4)< .01
    • pCS, primary cesarean section; rCS, Repeat cesarean section; SVD, spontaneous vaginal delivery; FM, Family Medicine; OB/Gyn, Obstetrics and Gynecology; PNC, Prenatal Care; SD, standard deviation.

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The Journal of the American Board of Family     Medicine: 34 (1)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 1
January/February 2021
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Social Inequities Between Prenatal Patients in Family Medicine and Obstetrics and Gynecology with Similar Outcomes
Michael Partin, Ana Sanchez, Jessica Poulson, Arthur Berg, Jessica Parascando, Sarah Ines Ramirez
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 181-188; DOI: 10.3122/jabfm.2021.01.200279

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Social Inequities Between Prenatal Patients in Family Medicine and Obstetrics and Gynecology with Similar Outcomes
Michael Partin, Ana Sanchez, Jessica Poulson, Arthur Berg, Jessica Parascando, Sarah Ines Ramirez
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 181-188; DOI: 10.3122/jabfm.2021.01.200279
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Keywords

  • Cesarean Section
  • Cohort Studies
  • Family Medicine
  • Gynecology
  • Internship and Residency
  • Obstetrics
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  • Prenatal Care
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