Roblin D, Roberts M; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1497.
Kaiser Permanente Georgia, Research Department, 3495 Piedmont Road, N.E., Building 9, Atlanta, GA 30305 Tel. 404.364.4805 Fax 404.364.4798
RESEARCH OBJECTIVE: In many managed care organizations (MCOs), women may obtain their gynecologic care from either an adult primary care (APC) or an obstetrics/gynecology (Ob/Gyn) practice. We analyzed a multi-year dataset from a mid-sized MCO to ascertain if patient characteristics or prior visit experience were associated with women obtaining gynecologic care in APC or Ob/Gyn. STUDY DESIGN: Retrospective observational study. Membership, visit, chronic disease history, and patient satisfaction survey records for 1997 through 2000 were obtained from the MCO computerized databases. Logistic regression was used to model the likelihood that an APC practice (vs. Ob/Gyn practice) provided a gynecologic visit as a function of patient characteristics (age, chronic disease status) and care experience in the prior 12-months. In the entire 4-year dataset (460,173 person-years), care experience was defined by department of service (APC or Ob/Gyn) and type of visit (general medical, gynecologic, obstetric). For the subset of records (N=4,930) with a completed patient satisfaction survey on a prior gynecologic visit, care experience was defined by satisfaction with care (practitioner interaction, case access, overall experience) by department of service. POPULATION STUDIED: 140,299 women at least 19 years of age who were provided either general medical care or gynecologic care on at least one visit to the 16 APC or 9 Ob/Gyn practices of this MCO. PRINCIPAL FINDINGS: From 1997-2000, between 20% and 26% of women per year obtained gynecologic care from an APC practice. Women who had an obstetric visit in the prior 12-months, a gynecologic visit in Ob/Gyn only, or a general medical visit in Ob/Gyn were significantly (p<0.01) less likely to obtain a subsequent gynecologic visit in an APC practice than an Ob/Gyn practice. On the other hand, women who had a gynecologic visit only in an APC practice, who were 55 years of age or older, or who had a pre-existing chronic disease were significantly more likely to obtain a subsequent gynecologic visit in an APC practice than an Ob/Gyn practice. High levels of satisfaction with practitioner interaction as well as overall experience on an Ob/Gyn practice visit significantly (p<0.01) decreased the likelihood that a woman obtained a subsequent visit for gynecologic care in an APC practice. CONCLUSIONS: In an MCO where women have a choice of obtaining care from an APC or Ob/Gyn practice, prior experience on a visit for gynecologic care in Ob/Gyn notably higher satisfaction with care from Ob/Gyn shifts gynecologic care to Ob/Gyn practices from APC practices. On the other hand, gynecologic care shifts from Ob/Gyn practices to APC practices among women with medical needs (older age, chronic disease) typically attended by family practice or internal medicine physicians. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Where women choose to obtain their gynecologic care has implications for allocation of resources to APC and Ob/Gyn practices. In capitated practices, adjustment for age, chronic disease, and prior distribution of gynecologic visits may be warranted.
Publication Types:
Keywords:
- Adult
- Ambulatory Care Facilities
- Data Collection
- Family Practice
- Female
- Gynecology
- Humans
- Interviews as Topic
- Obstetrics
- Patient Satisfaction
- Physicians
- Primary Health Care
- Retrospective Studies
- methods
- hsrmtgs
UI: 103624531
From Meeting Abstracts