Influence of Provider Characteristics and Insurance Status on Maternal Serum Alpha-Fetoprotein Screening

Abstract

Background:The maternal serum alpha-fetoprotein test (MSAFP) was developed to screen for neural tube defects. Little is known about the adoption of the MSAFP test. This study examines the effect of provider specialty and geographic location and patient insurance status on MSAFP test use in Washington State.Methods: We conducted a retrospective cohort study of MSAFP use in low-risk obstetric patients of five provider groups. MSAFP use was examined for Medicaid and privately insured patients, as well as for the patients of the five provider types.Results: Patients of urban and rural obstetrician-gynecologists were most likely to have MSAFP testing (80.4 percent and 77.0 percent, respectively); patients of urban certified nurse midwives and rural family physicians were least likely to have MSAFP testing (64.2 percent and 62.2 percent, respectively). Patients of certified nurse midwives were more likely to decline MSAFP testing when offered (26.1 percent). Medicaidinsured women were significantly less likely to have MSAFP testing than privately insured women (60.5 percent versus 79.1 percent, P::; 0.05).Conclusions: Providers and patients did not uniformly use MSAFP screening. Efforts should be made to ensure that all patients are adequately informed of screening tests for neural tube defects. (J Am Board Fam Pract 1998;11:357-65.)

Reproductive decisions of parents of children with metabolic disorders

“…Previous research has failed to identify consistent demographic or sociocultural predictors of parents' reproductive decisions (5, 7–16). Studies examine the impact of psychological and affective variables that on reproductive decisions have been somewhat more conclusive, and the idea that such variables are central concerns of genetic counselling is well established (17–22).…”