Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001-2004: part II

Pattern of Ambulatory Care Visits to Obstetrician-Gynecologists in Taiwan: A Nationwide Analysis

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.

Reporting vaccine complications: what do obstetricians and gynecologists know about the Vaccine Adverse Event Reporting System?

Background. Obstetrician-gynecologists are increasingly called upon to be vaccinators as an essential part of a woman's primary and preventive health care. Despite the established safety of vaccines, vaccine adverse events may occur. A national Vaccine Adverse Event Reporting System (VAERS) is a well-established mechanism to track adverse events. However, we hypothesized that many obstetrician-gynecologists are naive to the role and use of VAERS. Methods. We devised a ten-question survey to a sample of ACOG fellows to assess their knowledge and understanding of VAERS. We performed descriptive and frequency analysis for each of the questions and used one-way analysis of variance for continuous and chi-squared for categorical variables. Results. Of the 1000 fellows who received the survey, 377 responded. Only one respondent answered all nine knowledge questions correctly, and 9.2% of physicians had used VAERS. Older physicians were less familiar with VAERS in general and with the specific objectives of VAERS in particular (χ² = 10.7, P = .005). Conclusions. Obstetrician-gynecologist familiarity with VAERS is lacking. Only when the obstetrician-gynecologist is completely knowledgeable regarding standard vaccine practices, including the availability and use of programs such as VAERS, will providers be functioning as competent and complete vaccinators.

Attitudes of obstetrician-gynecologists toward the evidence from the Women's Health Initiative hormone therapy trials remain generally skeptical

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.

Provider knowledge, attitudes, and practices regarding obstetric and postsurgical gynecologic infections due to group A Streptococcus and other infectious agents

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.