Factors associated with the closure of German obstetric units and its effects on accessibility

Abstract Background An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. Methods Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Multivariate logistic regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. Results Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. Only the annual number of live births was observed to be a factor significantly associated with the closure of obstetrics departments (odds ratio: 0·995; confidence interval: 0.993-0.997). Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. Conclusions The annual number of live births is a factor significantly associated with the closure of obstetrics departments. Despite the closure, good accessibility is maintained for most areas in Germany. Although further regionalization may ensure high-quality care and efficiency, it will have an impact on accessibility. Key messages • Despite the closure of many obstetric departments, regional accessibility to obstetric care remains good for most areas in Germany. • Further regionalization may ensure high-quality care and efficiency but will have an impact on accessibility.


Background:
An increase in regionalization of obstetric services is being observed worldwide.This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care.

Methods:
Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019.Multivariate logistic regression was performed to identify factors associated with obstetrics department closure.Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled.

Results:
Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019.Only the annual number of live births was observed to be a factor significantly associated with the closure of obstetrics departments (odds ratio: 0Á995; confidence interval: 0.993-0.997).Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold increased from 2014 to 2019.Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of !600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold.

Conclusions:
The annual number of live births is a factor significantly associated with the closure of obstetrics departments.Despite the closure, good accessibility is maintained for most areas in Germany.Although further regionalization may ensure highquality care and efficiency, it will have an impact on accessibility.

Background:
Internet use in pregnancy is very prevalent.However, there are issues with information quality as well as acceptance by healthcare providers which can add to the frustration.Methods: An online anonymous survey, shared via Baby Buddy Cyprus, addressed women who are pregnant or recently gave birth in Cyprus.Adapting previously used questionnaires, the survey covered reasons and patterns of internet use, perceptions of trustworthiness, appraisal means and usefulness in decisionmaking.Results: Among 357 responses so far in this ongoing survey (38% pregnant, 62% new mums, 66% primiparas, 42% C/S, 78% private sector), searching online seems very frequent, even though 70% report coming across wrong or misleading information often.Checking for consistency across sites and/ or with information by healthcare provider (HP) is the most common technique for assessing trustworthiness.While the majority discuss information with HP, only half characterize their reception as positive and welcoming.As many as 89% believe that HP should recommend sites, but only 6.5% report their HP made recommendations.The role of the internet in assisting decision-making is rated as moderate (M = 3.0, SD = 1.0 on 5-point scale averaged across 11 items); yet more than half search online to be prepared and have control over decisions.Among reasons cited for using the internet is insufficient time with HP and/or is unclear or unsatisfactory information.While only 11.6% prepare material for the next appointment, 54.5 % use the internet to verify information given by HP or for a second opinion.

Conclusions:
While a prevalent source of information, the flow is problematic as it appears that women are more likely to search online to verify information rather than discuss this information with their providers.Insights about characteristics and attributes of internet use in pregnancy suggest that health services need to engage with, rather than ignore, this reality and offer appropriate guidance.

Key messages:
Pregnant women in Cyprus search for information online, due to insufficient time or information by healthcare providers, even though they recognize there are issues with quality and expect guidance.
In a landscape of unguided information-seeking, searching for consistency and verification, a shift in current practices is needed whereby healthcare providers and services engage with this reality.