Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study |
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| Institution: | 1. Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada;2. ICES, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada;3. Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, 1001 Queen St W, Toronto, Ontario, M6J 1H4, Canada;4. Department of Health & Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A5, Canada;1. Department of Physical Therapy, School of Health Professions, The University of Alabama at Birmingham, 360, 1720 2nd Ave S, Birmingham, AL, 35294, USA;2. Department of Kinesiology and Nutrition, The University of Illinois Chicago, 1919 W Taylor St, Chicago, IL, 60612, USA;1. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA;2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA;3. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA;4. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA;5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA;1. Department of Public Health Sciences, University of North Carolina at Charlotte, USA;2. Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA;1. Ontario Tech University, Faculty of Health Sciences, 2000 Simcoe St N. Oshawa, ON, L1G 0C5, Canada;2. ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada;3. University of Victoria, School of Exercise Science, Physical and Health Education, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada;4. SUNY Cortland, Department of Physical Education, P.O Box 2000, Cortland NY, 13045, USA;5. Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, ON, M6J 1H4, Canada |
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| Abstract: | BackgroundWomen 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.ObjectiveTo examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities.MethodsWe 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.ResultsWomen 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.ConclusionImproving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access. |
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| Keywords: | Cohort studies Disabled persons Primary health care Prenatal care Continuity of patient care |
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