Abstract and Introduction
Abstract
Background: The patient-centered medical home model may be a strategic approach to improve delivery of women's health care and consistently provide women with accessible and comprehensive care. We examined whether primary care physicians (family medicine, internal medicine, and hospital general medicine clinics) and obstetrician-gynecologists differ in scope and the number of medical issues addressed during preventive gynecologic visits.
Methods: We analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to characterize visits with a primary diagnosis of gynecological examination or routine cervical Papanicolaou test between 1999 and 2008. We compared the number and type of concurrent nongynecologic diagnoses addressed by primary care physicians and obstetrician-gynecologists during visits.
Results: A total of 7882 visits were included, representing 271 million primary visits for Papanicolaou tests. Primary care physicians were 2.41 times more likely to include one or more concurrent medical diagnoses during the preventive gynecologic visit compared with obstetrician-gynecologists (odds ratio, 2.41; 95% confidence interval, 1.63–3.57).
Conclusions: Primary care physicians are significantly more likely to address concurrent medical problems during preventive gynecologic visits compared with obstetrician-gynecologists. These findings demonstrate the vital role of primary care physicians in providing comprehensive health care to women, consistent with principles of the patient-centered medical home model.
Introduction
The patient-centered medical home and its key principles, including accessible, comprehensive, coordinated, and patient-centered care, have gained increasing attention as a national model to improve the organization and delivery of primary health care. In this model, a personal physician provides preventive, chronic, and acute services so that patients can receive continuous, integrated care throughout their lifetime. These principles may have particularly significant implications for the delivery of women's health care because women may sometimes require multiple visits with different providers and systems to address their gynecologic and medical needs.
For many women, a preventive gynecological visit may be their sole contact with medical care and an opportunity to address coexisting concerns and medical issues. Family medicine, internal medicine, and obstetrics/gynecology all provide care to women, but the extent to which they address multiple medical problems during a single encounter is unknown. Improved knowledge of the breadth and scope of care being provided during primary preventive gynecologic visits may have important implications for women's health care as we move forward with instituting patient-centered policies and models of care.
The aim of this study was to compare the number and type of concurrent medical diagnoses addressed by primary care physicians and obstetrician-gynecologists during visits with a primary purpose of gynecological examination or routine cervical Papanicolaou test. We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) between the years of 1999 and 2008.