Going the distance: the influence of practice location on the Ontario Maternal Serum Screening Program

Background: The Ontario Maternal Serum Screening (MSS) Program was introduc ed by the Ontario Ministry of Health as a province-wide pilot project in 19 93. The objective of this study was to determine the influence of practice location on Ontario health care providers' use of and opinions regarding MS S, access to follow-up services and recommendations about the program. Methods: A questionnaire was mailed to a random sample of 2000 family physi cians, all 565 obstetricians and all 62 registered midwives in Ontario betw een November 1994 and March 1995. Results: Among providers who were eligible (those providing antenatal care or at- I tending births) the response rates were 91.4% (778/851), 76.0% (27 3/359) and 78.0% (46/59) respectively. Fewer respondents in the Northwest r egion (71.4%) and in rural areas (81.9%) stated that they routinely offer M SS to all pregnant women in their practices compared with respondents in ot her regions (84.4%-91.5%) and urban centres (90.1%). Fewer respondents in t he northern regions (Northeast 49.2%, Northwest 25.0%) than in the Central East region (includes Toronto) (76.6%) felt that follow-up services were re adily available. Respondents in the northern regions had less favourable op inions of MSS than those in the other regions in terms of its complexity, c ost, the rime involved in counselling and the high false-positive rate. Mor e respondents in the Central East region (64.6%) and in urban centres (52.9 %) recommended not changing the MSS program than did those in the Northwest (7.1%) and rural areas (39.8%). After provider characteristics were contro lled for in a logistic regression analysis, practice location was not the m ost important factor. Instead, the model showed that respondents who cared for 50 or more pregnant women in the previous year were more likely to offe r MSS routinely (OR 2.00, 95% CI 1.21-3.27) and that those who felt that pa tient characteristics affect the offering of MSS (OR 0.42, 95% CI 0.26-0.67 ) or that follow-up services were not readily available (OR 0.33, 95% CI 0. 20-0.55) were less likely to offer it. Interpretation: Health care providers in northern and rural Ontario were le ss likely to offer MSS routinely than those in other regions and were more likely to recommend changing or eliminating the program. Providers' concern s about the social and cultural sensitivity of MSS and the availability of follow-up services affected use.