Is there a gap in preventative health care for women?

The majority of preventative health care visits among women of reproductive age were with obstetrician-gynaecologists (OB-GYNs), according to a University of Massachusetts Amherst study published in Health Services Research.

Preventative health may be more generally associated with primary care, but the research concluded that 61% of wellness visits for women aged 15–49 were with OB-GYNS and even those with chronic health conditions visited an OB-GYN for over 40% of their preventive care appointments.

The study’s findings also reveal that certain recommended services rarely occurred in any setting. Screening for depression, for example, happened in only 6% of primary care visits and just under 4% of visits with OB-GYNs, despite provisions for preventative health in the 2010 Affordable Care Act.

Health services researcher Laura Attanasio, assistant professor of health policy and management in the University of Massachusetts School of Public Health and Health Sciences and lead author of the study, said, “preventive care is important for helping people optimise their wellness”.

“There have been various policy measures over the years to try to increase people’s use of preventive care, including a provision in the Affordable Care Act, which required that certain preventive services be covered at no cost to patients for that visit or that service.”

Typically, these initiatives are “aimed at primary care, which doesn’t necessarily account for the fact that, in fact, reproductive-age women are largely seeing OB-GYNs for preventive care,” she added.

Attanasio and team analysed data from 2011 to 2018 from the National Ambulatory Medical Care Survey of office-based physicians which provided a national sample based on visits rather than on the care individuals received over time.

“When we looked at the services that were provided by physician type, we found not surprisingly that OB-GYNs emphasised more reproductive-related services — things like pap tests, pelvic exams and provision of contraceptive medications,” Attanasio said.

“Whereas in general practitioner visits the non-reproductive-related services were more common — things like lipid tests, glucose tests for diabetes and a complete blood count.”

Attanasio said 30% of visits with generalist physicians included lipid testing for cholesterol levels, compared to an “astonishingly low” 2.8% of visits with OB-GYNs.

“On the flip side, some reproductive-related services may be underprovided in primary care visits,” she said.

“We can just see that there are pretty big differences across physician specialty, including for women with chronic conditions.”

Attanasio suggested the reason for these discrepancies could be due to preventive care guidelines being updated frequently, which requires changes in clinical practice, plus the guidelines may differ across professional organisations. The study’s findings can inform additional research to determine where reproductive-age women — and particularly those with chronic conditions — should optimally receive preventive healthcare services.

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

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