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Rompalo AM, Castleberry N, Widdice L, Schulkin J, Gaydos CA. Patterns of point-of-care test use among obstetricians and gynaecologists in the US. Sex Health 2019; 15:318-324. [PMID: 29914611 DOI: 10.1071/sh17180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/25/2018] [Indexed: 12/22/2022]
Abstract
Background Point-of-care tests (POCTs) for reproductive health conditions have existed for decades. Newer POCTs for syphilis, HIV and trichomonas are currently available and easy to use. We surveyed practicing obstetricians and gynaecologists to determine current POCT use and perceived obstacles to use. METHODS Between June and August 2016, 1000 members of the American College of Obstetricians and Gynecologists were randomly selected and invited to complete a Qualtrics (222 West river Park Drive, Provo, Utah 84604, USA) survey; 600 of these were members of the Collaborative Ambulatory Research Network. Respondents who completed at least 60% of the survey were included in the analysis. RESULTS Of the 1000 selected members, 749 had valid emails and 288 (38%) of these participated in and completed the survey. Of the respondents, 70% were male with a mean of 18 years in practice. Detection of sexually transmissible infections (STIs) once or twice a week was reported by 30%, whereas 45% reported detecting STIs once or twice a month. POCTs used included pregnancy tests (83%), urine dipstick (83%), wet mount tests (79%) and the vagina pH test (54.8%). Few used Gram stain (5%) and stat rapid plasma regain tests (4%). Relatively newer US Food and Drug Administration-approved POCTs were used less frequently, with 25% of respondents reporting using the Affirm VPIII (Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ 07471, USA) test use and only 10% using a rapid HIV test. The most common perceived barriers to testing were the amount of reimbursement received for performing the test (61.9%) and the payment coverage from the patient (61.3%). CONCLUSIONS US obstetricians and gynaecologists rely on laboratory test results and traditional POCTs to diagnosis STIs. Future development and marketing of POCTs should consider not only ease and time of test performance, but also the cost of the tests to the practice and the patient, as well as reimbursement.
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Affiliation(s)
- Anne M Rompalo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkns Medical Institutions, 5200 Eastern Avenue, Mason F. Lord Center Tower, 3rd floor Infectious Diseases Suite, Baltimore, MD, 21223, USA
| | - Neko Castleberry
- The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC, 20024, USA
| | - Lea Widdice
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jay Schulkin
- The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC, 20024, USA
| | - Charlotte A Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkns Medical Institutions, 5200 Eastern Avenue, Mason F. Lord Center Tower, 3rd floor Infectious Diseases Suite, Baltimore, MD, 21223, USA
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Chang WT, Leu HI, Chen HP, Lin MH, Chen TJ, Hwang SJ, Chou LF, Wang PH. Temporal availability of obstetrics and gynecology clinics in Taiwan: A nationwide survey. Taiwan J Obstet Gynecol 2017; 56:636-641. [DOI: 10.1016/j.tjog.2017.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 10/18/2022] Open
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Lynn AM, Lai LJ, Lin MH, Chen TJ, Hwang SJ, Wang PH. Pattern of Ambulatory Care Visits to Obstetrician-Gynecologists in Taiwan: A Nationwide Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6832-41. [PMID: 26086705 PMCID: PMC4483733 DOI: 10.3390/ijerph120606832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022]
Abstract
Although obstetrician-gynecologists (OB-GYNs) are the main actors in the provision of health care to women, their practice patterns have rarely been analyzed. The current study investigated the nationwide ambulatory visits to OB-GYNs in Taiwan using the National Health Insurance Research Database. From the 1/500 sampling datasets indicating 619,760 ambulatory visits in 2012, it was found that 5.8% (n = 35,697) of the visits were made to OB-GYNs. Two-fifths of the services provided were performed by male OB-GYNs aged 50-59 years. Women of childbearing age accounted for more than half of the visits to OB-GYNs (57.2%), and elderly patients above 60 years accounted for only 7.7%. The most frequent diagnoses were menstrual disorders and other forms of abnormal bleeding from the female genital tract (13.1%). Anti-infective agents were prescribed in 15.1% of the visits to OB-GYNs. The study revealed the proportion of aging practicing OB-GYNs, and our detailed results could contribute to evidence-based discussions on health policymaking.
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Affiliation(s)
- An-Min Lynn
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Li-Jung Lai
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Peng-Hui Wang
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
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Power ML, Henderson Z, Behler JE, Schulkin J. Attitudes and practices regarding late preterm birth among American obstetrician-gynecologists. J Womens Health (Larchmt) 2013; 22:167-72. [PMID: 23350861 PMCID: PMC3573726 DOI: 10.1089/jwh.2012.3814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Late preterm birth (LPTB) accounts for most preterm births and has been increasing, associated with increases in cesarean sections and inductions at this gestational age. METHODS A self-administered survey, consisting of questions about opinions, knowledge, and practices regarding LPTB, was mailed to 1232 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in Practice in May-July 2010. RESULTS Surveys were returned by 520 practicing obstetricians.Two thirds of respondents defined LPTB as either 34–36 or 34–37 weeks gestation [corrected].Most responding physicians (87%) were aware of the evidence regarding morbidity and mortality of infants born at 34-36 weeks; 81% considered such evidence sufficient to make a clinical judgment. Although 84% were concerned about long-term health problems in these infants, many disagreed that LPTB infants were at increased risk of long-term neurodevelopmental outcomes. Most agreed that the increase in LPTB in the United States is due to increasing rates and complications of multifetal pregnancies and maternal disorders. Almost all responding physicians agreed that certain clinical indications (e.g., severe preeclampsia, placental abruption, premature rupture of the membranes [PROM]) were appropriate reasons for early delivery, and most disagreed with delivering late preterm infants for logistical reasons or convenience. Half of responding physicians reported that concerns about malpractice risks contribute to their decision to induce labor or perform a cesarean section at 34-36 weeks. CONCLUSIONS Many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm and may have a lower threshold to deliver some infants late preterm for indications that are not evidence based. Additional educational efforts regarding LPTB are needed.
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Affiliation(s)
- Michael L Power
- American College of Obstetricians and Gynecologists, Research Department, Washington, DC 20090-6920, USA.
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Byams VR, Anderson BL, Grant AM, Atrash H, Schulkin J. Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists. Am J Obstet Gynecol 2012; 207:269.e1-5. [PMID: 22901979 DOI: 10.1016/j.ajog.2012.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/20/2012] [Accepted: 07/10/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To better understand the current evaluation of unexplained menorrhagia by obstetrician-gynecologists and the extent to which a bleeding disorder diagnosis is being considered in this population. STUDY DESIGN A total of 1200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population and their evaluation of patients with unexplained menorrhagia. RESULTS The overall response rate was 42.4%. Eighty-two percent of respondents reported having seen patients with menorrhagia caused by a bleeding disorder. Seventy-seven percent of physicians reported they would be likely or very likely to consider a bleeding disorder as causing menorrhagia in adolescent patients; however, only 38.8% would consider bleeding disorders in reproductive age women. CONCLUSION The current data demonstrate that obstetrician-gynecologists seem to have a relatively high awareness of bleeding disorders as a potential underlying cause of menorrhagia.
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Affiliation(s)
- Vanessa R Byams
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention, Atlanta, GA, USA
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Power ML, Leddy MA, Anderson BL, Gall SA, Gonik B, Schulkin J. Obstetrician-gynecologists' practices and perceived knowledge regarding immunization. Am J Prev Med 2009; 37:231-4. [PMID: 19596538 DOI: 10.1016/j.amepre.2009.05.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 04/01/2009] [Accepted: 05/01/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obstetrician-gynecologists can play a key role in providing appropriate vaccinations to women of childbearing age. PURPOSE This study investigated immunization knowledge and practices, and opinions concerning potential barriers to immunization, among obstetrician-gynecologists. METHODS In 2007, surveys were sent to Collaborative Ambulatory Research Network members, a representative sample of practicing Fellows of the American College of Obstetricians and Gynecologists; 394 responded (51.2%). Data analysis was completed in 2008. RESULTS Most responding obstetrician-gynecologists disagreed that "routine screening for vaccine-preventable diseases falls outside of the routine practice of an ob/gyn." A majority (78.7%) stock and administer at least some vaccines. Among those who stock vaccines, 91.0% stock the human papillomavirus vaccine, and 66.8% stock the influenza vaccine. All other vaccines were stocked by <30% of practices that stock vaccines. A majority of physicians agreed that financial factors (e.g., inadequate reimbursement) were barriers to vaccine administration. Most were aware that the influenza (89.8%); hepatitis B (64.0%); and tetanus, diptheria, pertussis (58.6%) vaccines are safe to administer during pregnancy, and that the measles, mumps, rubella (97.5%); and varicella (92.9%) vaccines are not. Most (84.5%) were in concordance with recommendations that all pregnant women should receive the influenza vaccine. A majority believed their immunization training was less than adequate and believed their practice would benefit from continuing medical education courses. CONCLUSIONS Immunization is an important part of women's health care and has been, at least partially, incorporated into obstetrician-gynecologist practice. Financial burdens and knowledge regarding vaccine recommendations remain barriers to vaccine administration. Additional training and professional information may benefit obstetric-gynecologic practice.
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Affiliation(s)
- Michael L Power
- Research Department, American College of Obstetricians and Gynecologists, Washington, DC 20024, USA.
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Power ML, Cogswell ME, Schulkin J. US obstetrician-gynaecologist's prevention and management of obesity in pregnancy. J OBSTET GYNAECOL 2009; 29:373-7. [DOI: 10.1080/01443610902946911] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Power ML, Anderson BL, Schulkin J. Attitudes of obstetrician-gynecologists toward the evidence from the Women's Health Initiative hormone therapy trials remain generally skeptical. Menopause 2009; 16:500-8. [PMID: 19169162 PMCID: PMC2762611 DOI: 10.1097/gme.0b013e31818fc36e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the opinions of obstetrician-gynecologists regarding hormone therapy (HT) and the results from the Women's Health Initiative (WHI). METHODS Separate surveys were sent to two groups of practicing obstetrician-gynecologists: (1) respondents to a 2004-2005 survey (follow-up 1) and (2) members of the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network (follow-up 2 CARN). These studies complete a longitudinal study investigating obstetrician-gynecologists' opinions of the evidence from WHI. RESULTS Response rates were 64.5% and 58.8%, respectively. Responses from both surveys were generally consistent with the results from the 2004-2005 survey. A majority of physicians from both survey populations were skeptical of the combined HT results. Respondents were more likely to find the results of the unopposed estrogen trial convincing. Similar to the results from the 2004-2005 study, CARN physicians generally disagreed with the decision to end the WHI trials. Unlike the 2004-2005 study, there was no consistent effect of either age or year that residency was completed on physician opinions. Similar to the 2004-2005 study, physicians who considered alternative therapies as viable treatment options were more likely to report that they found the trial results convincing. The results from follow-up 2 CARN indicate that physicians in the south were most likely and physicians in the east were least likely to prescribe HT, suggesting that unmeasured sociocultural parameters might influence HT prescribing practice. CONCLUSIONS Obstetrician-gynecologists remain generally skeptical of the WHI results, although less so of the estrogen-only trial. The early end to the trials may have contributed to their skepticism.
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Affiliation(s)
- Michael L Power
- Research Department, American College of Obstetricians and Gynecologists, Washington, DC 20024, USA.
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Provider knowledge, attitudes, and practices regarding obstetric and postsurgical gynecologic infections due to group A Streptococcus and other infectious agents. Infect Dis Obstet Gynecol 2008; 2007:90189. [PMID: 18301725 PMCID: PMC2248426 DOI: 10.1155/2007/90189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 11/12/2007] [Indexed: 12/04/2022] Open
Abstract
Background. Knowledge, attitudes, and practices of obstetricians and gynecologists regarding the Centers for Disease Control and Prevention (CDC) recommendations for prevention of healthcare-associated group A streptococcal (GAS) infections as well as general management of pregnancy-related and postpartum infections are unknown.
Methods. Questionnaires were sent to 1300 members of the American College of Obstetricians and Gynecologists.
Results. Overall, 53% of providers responded. Postpartum and postsurgical infections occurred in 3% and 7% of patients, respectively. Only 14% of clinicians routinely obtain diagnostic specimens for postpartum infections; providers collecting specimens determined the microbial etiology in 28%. Microbiologic diagnoses were confirmed in 20% of postsurgical cases. Approximately 13% and 15% of postpartum and postsurgical infections for which diagnoses were confirmed were attributed to GAS, respectively. Over 70% of clinicians were unaware of CDC recommendations.
Conclusions. Postpartum and postsurgical infections are common. Providing empiric treatment without attaining diagnostic cultures represents a missed opportunity for potential prevention of diseases such as severe GAS
infections.
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Power ML, Cogswell ME, Schulkin J. Obesity Prevention and Treatment Practices of U.S. Obstetrician–Gynecologists. Obstet Gynecol 2006; 108:961-8. [PMID: 17012460 DOI: 10.1097/01.aog.0000233171.20484.db] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe obesity prevention and treatment practices of U.S. obstetrician-gynecologists. METHODS A cross-sectional survey was mailed to 1,806 practicing members of the American College of Obstetricians and Gynecologists (ACOG) in February-April 2005. RESULTS Of the 900 respondents who returned questionnaires, 82% reported using body mass index (BMI) to assess obesity; 80% reported counseling patients about weight control and 84% about physical activity "most of the time" or "often." Most reported counseling patients about diet; the most frequently recommended dietary strategies were changing eating patterns, limiting intake of specific foods, and controlling portion size. About 27% reported referring their patients for behavioral therapy "most of the time" or "often," and 35% reported ever prescribing weight loss medications to obese patients. More than 85% counseled patients about pregnancy weight gain, and 64% used the patients' prepregnancy BMI to modify their recommendations "most of the time" or "often." Respondents who completed their residency after 1996 were more likely to use patients' BMI to screen for obesity than those who finished earlier. Respondents who believed that they could help their patients lose weight (44%) were more likely to counsel their patients to do so (P < .001). CONCLUSION A majority of obstetrician-gynecologists appear to use BMI to screen for obesity and to counsel their patients about weight control, diet, and physical activity. Many, however, do not prescribe weight loss medications or refer patients to behavioral weight loss therapy. Obstetrician-gynecologists who believe they can help patients lose weight are more likely to follow recommendations for the treatment of obesity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael L Power
- Department of Research, American College of Obstetricians and Gynecologists, Washington, DC 20024, USA.
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