Provider and district continuity and fragmentation of care during pregnancy and delivery in the Volta Region, Ghana.

Provider and District Continuity and fragmentation of care during pregnancy and delivery

  • Samuel K.K Dery Department of Biostatistics, School of Public Health, University of Ghana
  • Ernest T. Maya Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana
  • Moses Aikins Department of Health Policy Planning and Management, School of Public Health, University of Ghana
DOI: https://doi.org/10.46829/hsijournal.2024.6.5.1.588-595
Keywords: Fragmentation of care, continuity of care, provider continuity, delivery, social network analysis, health insurance claims data

Abstract

Background: Continuity of care (CoC) measures the extent to which a patient is attended to by a given provider over a specified period. It can be measured at the level of a patient to a provider or at the level of a provider to determine the average proportion of care provided by the provider.

Objective: The study aimed to determine the extent of provider and district continuity of care and the level of care fragmentation among districts during antenatal and delivery.

Methods: National Health Insurance claims data for 2013 in the Volta Region was used for the study, with 14,474 pregnant women meeting the inclusion criteria of delivery at a health facility and making at least two antenatal care visits. Provider continuity of care was calculated, and a social networking analysis approach was used to determine the level of care fragmentation across districts based on patient-sharing among districts. Network graphs were constructed to help visualise the fragmentation of care among districts during antenatal care and delivery.

Results: There were 196 providers from 26 districts involved in the study; 15% (n = 2,185) of the pregnant women had caesarean section (CS) delivery. The average provider and district continuity of care scores were 67% and 81%, respectively. About 12.70% (n = 1838) of all deliveries and 19.95% (n = 436) of all caesarean section deliveries were fragmented across districts. Among those with multiple providers, about 30.51% (n = 1,838) of all deliveries and 45.41% (n = 436) of CS were fragmented across districts. Eight districts that do not have hospitals located in them had more fragmentation during delivery (25% - 81%) compared to districts with hospitals.
Conclusion: Fragmentation of care during antenatal care and delivery was higher in districts without hospitals compared to districts with hospitals.

Published
2024-06-11
Issue
Vol 5 No 1 (2024): Health Sciences Investigations Journal
Section
Original Research Article