Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study.
Fareha Nishat, Yona Lunsky, Lesley A Tarasoff and 1 others
PMID 35440405WHAT IT FOUND
Women with disabilities who lacked a consistent primary care provider before pregnancy were more likely to have inadequate prenatal care.
They also had higher odds of late entry into care and receiving intensive prenatal visits clustered late in pregnancy, rather than timely, consistent monitoring.
Key findings
01Women with low continuity of care had increased odds of receiving no, inadequate, or intensive prenatal care compared to adequate care.
02Low continuity of care was associated with later entry into prenatal care (second or third trimester) and receiving fewer than the recommended number of visits.
03The association between low continuity of care and inadequate prenatal care was consistent across physical, sensory, and intellectual/developmental disability groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Disability status was identified using diagnostic codes, which may misclassify women who did not access healthcare or whose disability was not recorded. The study excluded women with fewer than three primary care visits, potentially missing the most underserved individuals. Midwifery care was not captured in the data. Continuity of care was measured by visit concentration, not the quality of the provider-patient relationship or communication. Residual confounding from unmeasured factors like racism, ableism, or lack of social support cannot be ruled out.
Declared interests
None to declare.
The easy way to misread this
Do not interpret the finding that low continuity of care leads to 'intensive' prenatal care as a positive outcome. The study notes that this 'intensive' care was often characterized by late entry into pregnancy, meaning the care was clustered in the latter part of the pregnancy rather than providing the early, consistent monitoring that prevents complications.