How has the integration of midwives into primary healthcare settings impacted access to care? A qualitative descriptive study from Ontario, Canada

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PROBLEM: Most primary health care settings in Canada do not offer midwifery care. Midwifery remains poorly understood in Canada by some members of the public and healthcare providers. BACKGROUND: Most midwives in Canada work in community-based midwifery-led continuity of care models that are not integrated into interprofessional primary healthcare settings. AIM: To investigate perceptions of how integrating midwives into primary health care teams impacts access to care. METHODS: We conducted a qualitative descriptive study of expanded midwifery care models in Ontario, Canada. We completed 28 semi-structured interviews with midwives, other healthcare providers, healthcare administrators and policy makers. Interviews were audio recorded, transcribed, and then coded using open coding followed by axial coding in NVivo. We used Levesque et al.'s (Int J Equity Health 12:18, 2013) conceptualization of access to care to inform the interview questions and organize our findings. FINDINGS: We identified themes related to each of Levesque et al.'s supply side dimensions of access to care. Integrating midwives increased visibility and trust of the profession (approachability and acceptability), decreased access barriers such as travel time and cost (affordability), increased collaboration between healthcare providers (appropriateness), and ensured more timely and available care (availability and accommodation). DISCUSSION: Integrating midwives into primary healthcare settings can improve access to care, particularly for groups underserved by midwives. Integrating midwifery-led care within interprofessional teams can also enhance care appropriateness for equity-deserving populations. CONCLUSION: While stand-alone community-based midwifery care remains effective and efficient, policy makers should consider creating or expanding funding that supports the further integration of midwives into primary healthcare teams.

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