Dataset Information

Preventive care visits with OB/GYNs and generalist physicians among reproductive-age women with chronic conditions.

ABSTRACT:

Objective

To examine services delivered during preventive care visits among reproductive-age women with and without chronic conditions by physician specialty.

Data sources

National Ambulatory Medical Care Surveys (2011-2018).

Study design

We examined provision of specific services during preventive care visits by physician specialty among reproductive-age female patients, overall and among women with five common chronic conditions (diabetes, hypertension, depression, hyperlipidemia, and asthma).

Data collection/extraction methods

The sample included preventive visits to OB/GYNs or generalist physicians where the patient was female, age 18-44, and not pregnant.

Principal findings

In OB/GYN preventive visits, reproductive health services were more likely to be provided, while non-reproductive health services were less likely to be provided, both among reproductive-age female patients overall and among those with chronic conditions. For example, pap tests were provided in 44.5% of OB/GYN preventive visits (95% CI: 40.6-48.4) and in 21.4% of generalist preventive visits (95% CI: 17.2-26.6). Lipid testing was provided in 2.8% of OB/GYN preventive visits (95% CI: 1.7-3.9) and in 30.3% of generalist preventive visits (95% CI: 26.1-34.6).

Conclusions

Understanding the full range of care received in preventive visits across settings could guide recommendations to optimize where reproductive-age women with chronic conditions seek care.

SUBMITTER: Attanasio L

PROVIDER: S-EPMC9836949 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Preventive care visits with OB/GYNs and generalist physicians among reproductive-age women with chronic conditions.

Attanasio Laura L Ranchoff Brittany B Jeung Chanup C Goff Sarah S Geissler Kimberley K

Health services research 20221124 1

<h4>Objective</h4>To examine services delivered during preventive care visits among reproductive-age women with and without chronic conditions by physician specialty.<h4>Data sources</h4>National Ambulatory Medical Care Surveys (2011-2018).<h4>Study design</h4>We examined provision of specific services during preventive care visits by physician specialty among reproductive-age female patients, overall and among women with five common chronic conditions (diabetes, hypertension, depression, hyperl ...[more]

PMID: 36369964

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Project description:BACKGROUND:Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda. METHODS:This study is cross-sectional using secondary data from the 2014-15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15-49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately. RESULTS:Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results. CONCLUSION:The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

Project description:BackgroundAlthough many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain.ObjectiveTo describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs.DesignCross-sectional study and time trend analysis.DataNationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997-2010.Main measuresProportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality.Key resultsAmong 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p?=?0.04). The proportion of medical specialist visits in which the physician self-identified as the patient's PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p?<?0.01). Medical specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p?<?0.01), primarily for preventive care (54.0 %, p?<?0.01). Quality of care for cardiovascular disease was better in visits to cardiologists than in visits to generalists, but was similar or better in visits to generalists compared to visits to other medical specialists.ConclusionsMedical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/gynecologist PCPs serve different primary care roles for different populations. Delivery redesign efforts must account for the evolving role of generalist and specialist PCPs in the delivery of primary care.

Dataset Information

Preventive care visits with OB/GYNs and generalist physicians among reproductive-age women with chronic conditions.

Objective

Data sources

Study design

Data collection/extraction methods

Principal findings

Conclusions

Publications

Preventive care visits with OB/GYNs and generalist physicians among reproductive-age women with chronic conditions.

Similar Datasets

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