Bridging the Gaps in Obstetric Care: Perspectives of Service Delivery Providers on Challenges and Core Components of Care in Rural Georgia
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Objectives In 2011, a workforce assessment conducted by the Georgia Maternal and Infant Health Research Group found that 52 % of Primary Care Service Areas outside metropolitan Atlanta, Georgia, had an overburdened or complete lack of obstetric care services. In response to that finding, this study’s aim was twofold: to describe challenges faced by providers who currently deliver or formerly delivered obstetric care in these areas, and to identify essential core components that can be integrated into alternative models of care in order to alleviate the burden placed on the remaining obstetric providers. Methods We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and maternal and infant health leaders in Georgia. Interviews were digitally recorded, transcribed verbatim, uploaded into MAXQDA software, and analyzed using a Grounded Theory Approach. Results Providers faced significant financial barriers in service delivery, including low Medicaid reimbursement, high proportions of self-pay patients, and high cost of medical malpractice insurance. Further challenges in provision of obstetric care in this region were related to patient’s late initiation of prenatal care and lacking collaboration between obstetric providers. Essential components of effective models of care included continuity, efficient use of resources, and risk-appropriate services. Conclusion Our analysis revealed core components of improved models of care that are more cost effective and would expand coverage. These components include closer collaboration among stakeholder populations, decentralization of services with effective use of each type of clinical provider, improved continuity of care, and system-wide changes to increase Medicaid benefits.
KeywordsGeorgia Obstetrics-gynecology Rural Certified-nurse midwives Advanced nurse practitioners Shortage
We are indebted to the men and women who shared their experiences and perspectives for this project. We would like to express our sincere appreciation to Pat Cota, RN, MS, Andrew Dott, MD, MPH, and all of the research assistants who conducted the interviews for this project, including Ayanna Williams, Jessica Harnisch, Erika Meyer, and Lauren Espinosa. All of your guidance and support throughout the planning and implementation of this project was invaluable. Thank you also to the March of Dimes Foundation, Georgia Obstetrical and Gynecological Society, and the Georgia Department of Public Health for their financial support.
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