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Preventive services differ between primary care docs and OB/GYNs

By Andrew M. Seaman

NEW YORK (Reuters Health) - The services women receive during annual preventive care visits may partially depend on what type of doctor they see, suggests a new report.

Women who saw primary care doctors for their annual checkup tended to receive a broader range of services, compared to those who saw obstetrician/gynecologists (OB/GYNs), researchers found.

“I think (primary care providers) and OB/GYNs can play an important role in clinical preventive services,” said Dr. Mona Saraiya, one of the study’s authors. “I think it’s important to be aware where there might be deficits.”

Saraiya is an associate director within the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention in Atlanta.

She and her co-authors write in JAMA Internal Medicine that well-woman preventive care visits are a core service supported by the U.S. Health Resources and Services Administration (HRSA).

Well-woman visits should occur every year for women to get the recommended preventive services, which include blood pressure checks, tests for sexually transmitted infections and cancer screenings, according to HRSA.

For the new study, the researchers analyzed medical records from between 2007 and 2010 to see what services women typically receive during a well-woman visit with a primary care doctor compared to an OB/GYN.

They had data on about 281 million medical visits that occurred during that time. Of those, about 63 million were for preventive care.

The researchers found that 44 percent of preventive care visits were to OB/GYNs and 56 percent were to primary care doctors.

Women who were 50 years old or older were more likely than younger women to see a primary care doctor for their preventive care.

Saraiya and her colleagues found that women who saw OB/GYNs were more likely to get screened for cervical and breast cancers, Chlamydia and osteoporosis, compared to those who went to primary care doctors.

Those who went to primary care doctors were more likely to get screened for colon cancer, high cholesterol and diabetes and to be counseled about diet, exercise and obesity, however.

The researchers could not assess how often doctors counseled women about contraceptives because of limitations with the data.

Counseling for other health matters, such as smoking, was low among women who went to either OB/GYNs or primary care doctors.

Because women who went to primary care doctors tended to receive a wider range of services, the researchers write that “women of reproductive age who see OB/GYNs only for preventive care may not be receiving the full spectrum of recommended screening and counseling.”

Saraiya said there could be room for OB/GYNs to provide more services to fill in any gaps. Also, primary care doctors in rural areas may be able to provide more services when OB/GYNs are not easily accessible.

The American Congress of Obstetricians and Gynecologists (ACOG) does not have an official statement about whether OB/GYNs should also serve as primary care providers. It does endorse annual well-woman visits, however.

A spokesperson for ACOG wrote in an email to Reuters Health that most state Medicaid programs recognize that OB/GYNs play a part in primary care.

Saraiya said it will be useful to go back and look at additional data to see if there are changing trends in the preventive services women receive.

“We want to make sure we document where there could be room for improvement,” she said.

SOURCE: http://bit.ly/1n8GLAW JAMA Internal Medicine, online July 7, 2014.

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