Preventive services use among women seen by gynecologists, general medical physicians, or both
Preventive services use among women seen by gynecologists, general medical physicians, or both
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DOI：
10.1097/aog.0b013e318169ce3e
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发表时间：
2008-04-01
影响因子：
7.2
通讯作者：
Federman, Alex D.
中科院分区：
文献类型：
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作者：
Lewis, Beth G.;Halm, Ethan A.;Federman, Alex D.
目的：估计预防服务和咨询如何不同的妇女看到的一般内科医生和妇科医生，以及是否看到这两种类型的医生有更大的影响，提供性别特异性和性别中立的预防保健比任何类型的医生单独.方法：利用2000年全国健康访谈调查的数据，我们研究了提供者类型与巴氏试验、烟草使用筛查、为18-64岁的妇女（n= 7 317）提供运动和饮食咨询，并为50-64岁的妇女（n= 1 551）提供沿着这些服务以及临床乳房检查、乳房X光检查和结肠癌筛查。我们使用多变量logistic回归模型的护理和使用倾向评分技术，以限制选择偏差从选择provider.RESULTS：在研究样本中，15%的普通内科医生，62%的妇科医生，和23%的两者。按性别区分的服务（巴氏试验、临床乳房检查、乳房X光检查）的总体比率很高（88-95%），而不分性别的服务则很低（23-53%）。只有妇科医生的患者更有可能进行巴氏试验（调整的相对风险[RR] 1.26，95%置信区间[CI] 1.24-1.27），烟草使用筛查（校正RR 1.08，95% CI 1.02-1.14），乳腺X线摄影（调整后RR 1.25，95% CI 1.20-1.28）和临床乳腺检查（调整后RR 1.25，95% CI 1.19-1.29）。一般来说，妇科医生和一般护理相结合并没有增加预防性护理的可能性。倾向评分分析证实了这些results.CONCLUSION：妇科医生的患者接受更多的预防性服务与普通内科医生的患者相比，虽然性别中立的服务率低，无论供应商类型。这些研究结果证实了妇科医生作为基本预防保健服务提供者的作用，但也表明，在向妇女提供预防保健方面还有相当大的改进余地。
OBJECTIVE: To estimate how preventive services and counseling differ for women seen by general medical physicians and gynecologists, and whether seeing both types of physicians had a greater impact on delivery of gender-specific and gender-neutral preventive care than by either type of physician alone.METHODS: Using data from the 2000 National Health Interview Survey, we studied the association of provider type with Pap tests, tobacco use screening, and exercise and diet counseling among women 18-64 years (n=7,317), and these services along with clinical breast examinations, mammograms, and colon cancer screening among women aged 50-64 years (n=1,551). We modeled care using multivariable logistic regression and used propensity score techniques to limit selection bias from choice of provider.RESULTS: In the study sample, 15% were seen by general medical physicians, 62% by gynecologists, and 23% by both. Overall rates of gender-specific services (Pap test, clinical breast examination, mammography) were high (88-95%), whereas gender-neutral services were low (23-53%). Patients of gynecologists only were more likely to have Pap tests (adjusted relative risk [RR] 1.26, 95% confidence interval [CI] 1.24-1.27), tobacco use screening (adjusted RR 1.08, 95% CI 1.02-1.14), mammography (adjusted RR 1.25, 95% CI 1.20-1.28), and clinical breast examination (adjusted RR 1.25, 95% CI 1.19-1.29). In general, combined gynecologist and general care did not increase the likelihood of preventive care. Propensity score analyses confirmed these results.CONCLUSION: Patients of gynecologists receive more preventive services compared with patients of general medical physicians, although rates of gender-neutral services were low regardless of provider type. These findings validate gynecologists' roles as providers of basic preventive care services but demonstrate that considerable room exists to improve delivery of preventive care to women.