Women in Michigan who suffer miscarriages may not be receiving patient-centered care
Research Activities, December 2009, No. 352
A woman who suffers a miscarriage has several treatment options. She can wait to see if the miscarriage progresses naturally (expectant management), take a drug called misoprostol to speed up the miscarriage, or have surgery (uterine evacuation) in a medical office or a hospital. In Michigan, however, providers' attitudes appear to be dictating treatment by expectant management or surgery in a hospital operating room, a new study finds. Vanessa K. Dalton, M.D., M.P.H., of the University of Michigan Medical School, and colleagues identified 21,311 women enrolled in Michigan's Medicaid program and 1,493 women from a university-affiliated health plan in Michigan who experienced miscarriages.
The women covered by Medicaid were more likely to be treated with surgery (35 percent) than the women enrolled in the university plan (18 percent). In addition, just 0.5 percent of the Medicaid enrollees had surgery in medical offices, while nearly 31 percent of the university plan's women underwent office procedures. This most likely occurred because the latter women had access to a network of providers who offered this service while the Medicaid-insured women did not. Once the university plan offered office uterine evacuations, researchers saw a movement away from hospitals and toward medical offices. However, this option may have also led some women and providers to choose surgery in lieu of expectant management or misoprostol use, which was low for both the Medicaid group and the university plan.
The primary factor in determining treatment patterns for miscarriages appears to be having access to providers who offer a range of services, the authors suggest. Some providers may shy away from in-office surgeries because the procedure is so similar to induced abortions. Expanding treatment options for miscarriage so that they reflect patient preferences will have the dual effect of improving patient care and decreasing health care resource use, the authors suggest.
This study was funded in part by the Agency for Healthcare Research and Quality (HS15491). See "Treatment patterns for early pregnancy failure in Michigan," by Dr. Dalton, Lisa H. Harris, M.D., Ph.D., Sarah J. Clark, M.P.H, and others in the June 2009 Journal of Women's Health 18(6), pp. 787-793.