10/10/2016

MODELOFFAMILYMEDICINEANDOBSTETRICSGYNECOLOGYCOLLABORA...:Obstetrics&Gynecology

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Obstetrics&Gynecology:
August2000Volume96Issue2p308313
GraduateEducation

MODELOFFAMILYMEDICINEANDOBSTETRICSGYNECOLOGYCOLLABORATIONINOBSTETRICCARE
ATTHEUNIVERSITYOFMICHIGAN
Berman,DeborahR.MDJohnson,TimothyR.B.MDApgar,BarbaraS.MD,MSSchwenk,ThomasL.MD

Abstract
Objective:Toassessconcordancebetweenfamilyphysicianobstetricprivilegedelineationand
actualcaredelivered,anddescribeassociatedclinicalandeducationalcollaborationsbetween
familymedicineandobstetricsandgynecology.
Methods:Weconductedadescriptiveretrospectivereviewofthecareandcomplicationsof962
consecutivepatientsadmittedtoafamilymedicineobstetricserviceinaresearchintensive
academicmedicalcenter,andcomparedtheresultswithastructuredobstetricprivilege
delineation.
Results:Of962womenadmittedbyfamilymedicinefacultymembers,741(77.9%)were
managedexclusivelybyfamilyphysicians,63(6.6%)werecomanagedbyfamilyphysicians
andobstetricians,and147(15.5%)weretransferredtoobstetricians(datamissingfor11
patients).Spontaneousvaginaldeliverieswereperformedin772patients(81%),cesarean
deliveryin116patients(12.2%),andassisteddeliverybyforcepsorvacuumin19(2%)and44
(4.6%)patients,respectively.Of926intrapartumobstetriccomplicationsidentifiedin604
obstetricdeliveries,615complications(66.4%)in418deliveriesweremanagedexclusivelyby
familyphysiciansconsistentwithprivilegedelineation,comanagementoccurredin56patients
with92complications(9.9%),andcarewastransferredin130patientswith219
complications(23.7%).
Conclusion:Astructuredmethodofobstetricprivilegedelineationforfamilymedicinefaculty
membersandassociatedguidelinesforfamilyphysicianobstetricianinteractionshasledtoa
successfulfamilymedicineobstetricserviceataresearchintensive,tertiarycaremedical
center,withahighconcordancebetweenprivilegedelineationandactualcaredelivered.This
successhasresultedinincrementalclinicalandeducationalcollaborationsthathave
improvedthequalityofwomen'shealthcareandeducation.
Manydisciplinesandspecialtiessharecommonareasofmedicalcareexpertise,butthe
relationshipbetweenfamilymedicineandobstetricsandgynecologyhashistoricallybeenone
ofparticularintensityandcontroversy.Thecareofwomen,includinglowriskobstetriccare,
isacorecomponentoffamilypracticeresidencytraining.1AjointtaskforceoftheAmerican
AcademyofFamilyPhysiciansandtheACOGhasdevelopedrecommendationsforcore
educationalobjectivesandcooperativepracticetosupportthistrainingandpractice,2butthe
experienceofmanypracticingfamilyphysiciansisthat,becauseobstetriciansfrequentlyview
allobstetriccareaspotentiallyhighrisk,theyactivelydiscouragefamilyphysiciansfrom
practicingevenlowriskobstetrics.3Essentiallyallofthefewstudiesexaminingdelivery
outcomesforfamilyphysiciansoriginateinfamilymedicine,arepublishedinfamilymedicine
journals,andshowthatoutcomesarecomparable,46butthecomparabilityofthestudy
populationsisoftenquestionedandthelowrisknatureofthestudypopulationsmakesan
assessmentofprivilegedelineationandconsultationbehaviordifficult.Onestudyfound
comparableoutcomesinthecareofgestationaldiabeticpatientsbyfamilyphysiciansand
obstetricians.7Themainfindingofotherstudiesthathaveexploreddifferencesinobstetric
practicebetweenfamilyphysiciansandobstetricianshasbeenthatfamilyphysiciansappear
tousealessinterventionisticstyleofpractice.810Suchcomparisons,however,havenot
exploredthecollaborativenatureofobstetricpractice,particularlyinresearchintensive,
tertiarycaremedicalcenters.Thelackofsuchcollaborationoftenleadstoconsiderable
controversy,frequentmeetingstoarbitrateconflicts,mutualsuspicion,resentmentamong
familymedicineandobstetricsandgynecologyfacultyandresidents,anddifficultyin
initiatingotherpotentiallyproductivecollaborations,particularlyeducationalcollaborations

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10/10/2016

MODELOFFAMILYMEDICINEANDOBSTETRICSGYNECOLOGYCOLLABORA...:Obstetrics&Gynecology
thatwouldenhancetheobstetrictrainingoffamilyphysiciansorhelpobstetricsand
gynecologymeetnewresidencyrequirementsinprimarycaretraining.11,12
Wedescribeourexperiencewithastructured,explicitapproachtocollaborativeobstetric
practiceattheUniversityofMichiganMedicalCenter,withparticularattentiontoadetailed
methodofprivilegedelineationandphysiciancredentialing,thesuccessofwhichhasledto
severalcollaborativeclinicalandeducationalprograms.

2000TheAmericanCollegeofObstetriciansandGynecologists

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