Where do reproductive-age women receive preve

Health services researcher

photo: Laura Attanasio is an assistant professor of health policy and management at the UMass Amherst School of Public Health and Health Sciences.
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Credit: Mass Amherst

Although preventive health care is often associated with primary care providers, the majority of office visits for preventive services among women of reproductive age occur with gynecologists (OB-GYNs), a University of Massachusetts Amherst study shows.

Even among women of reproductive age with chronic health conditions, more than 40% of preventive care visits were with OB-GYNs. The research findings also reveal that some recommended services are rarely available in any setting. For example, stress screening occurred in only 6% of primary care visits and just under 4% of visits with OB-GYNs.

Health services researcher Laura Attanasio, assistant professor of health policy and management at the University of Massachusetts School of Public Health and Health Sciences, is the lead author of a study published in Health Services Research that examines the services women — especially those with chronic conditions — receive. in preventive visits since the passage of the Affordable Care Act in 2010.

“Preventive care is important in helping people improve their health,” Attanasio said. “There have been various policy initiatives over the years to try to increase the way people use preventive care, including the provision of the Affordable Care Act, which required that certain preventive services be covered at no cost to patients for that visit or service.”

Generally, these programs are “directed toward primary care, which doesn’t account for the fact that, in fact, women of childbearing age see more OB-GYNs for preventive care,” she adds.

Attanasio and team analyzed data from 2011 to 2018 from the National Ambulatory Medical Care Survey of office-based physicians. Specifically, they looked at preventive care visits among women of reproductive age at an OB-GYN office or a general practitioner setting – be it a family practice, internist or pediatrician.

The data provide a national sample based on visits rather than receiving care over time.

“When we looked at the services provided by the type of doctor, we found that it is not surprising that OB-GYNs emphasize fertility-related services – things like pap smears, pelvic exams and the provision of contraceptives,” Attanasio said. “Although most of the doctor’s visits were for non-reproductive services they were more common – things like lipid tests, diabetes glucose tests and complete blood counts.”

The patterns were similar for the entire reproductive patient population and women when the sample was limited to women of reproductive age with chronic conditions, including depression, diabetes, asthma, high blood pressure and high cholesterol.

Another 30% of visits with general practitioners include a lipid test for cholesterol levels, compared to a “dramatic decrease” of 2.8% of visits with OB-GYNs, Attanasio said.

“On the other hand, some fertility-related services may be underserved in primary care visits,” he said. “We’re just seeing that there’s a huge difference in the overall skill set of doctors, including women with chronic conditions.”

There are reasons for that, Attanasio said. Prevention guidelines are updated frequently, requiring changes in clinical practice, and guidelines may differ across professional organizations. The findings of this study can inform further research to determine when women of reproductive age – and especially those with chronic conditions – should receive preventive health services.

The paper concludes, “Our results provide basic information about the frequency of services in preventive visits; given the gradual and uneven incorporation of new guidelines into clinical practice, trends in service delivery are likely to continue.”

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