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Managed Care

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Many women enrolled in HMOs prefer to see an OB/GYN for routine gynecological care

Some managed care plans encourage women to accept gynecological care as part of the routine care they receive from their primary care physician providers. However, a recent study suggests that many women prefer to receive routine gynecological care from an obstetrician/gynecologist. Survey responses from 5,164 women (35 years and older) in a large group model health maintenance organization (HMO) in Northern California revealed that 56 percent of the women had seen a gynecologist for their last pelvic examination, 26 percent had seen a nurse practitioner, and only 18 percent had seen their own primary care physician (PCP). Of these women, 60 percent said they preferred a gynecologist for basic gynecology care, 13 percent preferred a nurse practitioner, 13 percent preferred their own PCP, and 14 percent had no preference.

A woman's prior experience was the strongest predictor of physician preference. For example, the strongest independent predictor of preferring a gynecologist over a PCP was having seen a gynecologist for the last pelvic exam. The past policies of this particular HMO often dictated that women see either gynecologists or nurse practitioners for routine gynecologic care. Thus, most women in this HMO had become accustomed to relying on practitioners other than their PCP to provide basic pelvic exams and breast cancer screening and they had received care in a system that treated this as the norm. Women who had been with their PCP longer and women who saw family physicians were more apt to prefer that physician as the provider of their basic gynecological care.

These findings suggest that women's preferences are not set in stone. They may come to value the continuity and comprehensiveness of basic gynecological care provided by their own PCP once they have had a chance to build a significant relationship with that provider, suggests principal investigator Joe V. Selby, M.D., M.P.H., of the Kaiser Permanente Medical Care Program, Northern California Region. This research was supported by the Agency for Healthcare Research and Quality (HS08269).

See "Women's provider preferences for basic gynecology care in a large health maintenance organization," by Julie Schmittdiel, M.A., Dr. Selby, Kevin Grumbach, M.D., and Charles P. Quesenberry Jr., Ph.D., in the Journal of Women's Health and Gender-Based Medicine 8(6), pp. 825-833, 1999.

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