Race and satisfaction in general OB/GYN clinics

Background  

The purpose of this study was to test the hypothesis that racial differences in satisfaction can be found among OB/GYN patients on a US naval base.     

Patient expectations and marketing programming for OB/GYN services

A regional medical center OB/GYN practice was perceived as being too large to give personalized attention. A combination of growing market potential and declining market share caused the center administrators to take a bold step and design, open, and operate a new parallel OB/GYN practice. The practice was developed based on analysis of patient perceptions and needs. Research results were used to develop a marketing program. The project involved doctors, nurses, and staff who were interested in patient perceptions and were willing to adjust health care delivery to satisfy patients' expectations.     

Patient Expectations and Marketing Programming for OB/GYN Services

ABSTRACT

A regional medical center OB/GYN practice was perceived as being too large to give personalized attention. A combination of growing market potential and declining market share caused the center administrators to take a bold step and design, open, and operate a new parallel OB/GYN practice. The practice was developed based on analysis of patient perceptions and needs. Research results were used to develop a marketing program. The project involved doctors, nurses, and staff who were interested in patient perceptions and were willing to adjust health care delivery to satisfy patients' expectations.     

OB/GYN virtual consult--menorrhagia for 6 months in a 31-year-old

What treatment options would you advise for a young woman with vaginal bleeding of 6 months' duration? Malcolm Griffiths, MD, in the Department of Obstetrics and Gynaecology, Luton & Dunstable Hospital, Luton, UK, moderates this case.     

Effect of CME on primary care and OB/GYN treatment of breast masses

INTRODUCTION: CME program planners are being asked to move beyond assessments of knowledge to assessing the impact of CME on practice and patient outcomes. METHODS: We conducted a pre-post analysis of administrative data from 107 physicians, nurse practitioners (NPs), or physician's assistants (PAs) who attended one or two continuing medical education (CME) programs (an in-person, mainly didactic session on breast complaints in women, or an individual mentorship with general surgeons) between August 2002 and March 2003. We examined associations between the number of trainings and attempted breast mass aspirations or general surgery referrals for breast masses; individual training and breast mass aspiration attempts or general surgery referrals; and provider type and attempted breast mass aspirations. Generalized linear mixed models were used to model dichotomous outcomes. RESULTS: Clinicians who participated in individual trainings performed more breast mass aspirations after training (odds ratio (OR) 3.07, [95% confidence interval 1.10-8.54]). Participants who completed two trainings performed more breast mass aspirations after training (OR 2.33, [1.19-4.57]), while those who completed just one did not (OR 1.34, [0.39, 4.58]) but the effect started after the first training and did not strengthen after the second training. NPs and PAs attempted more aspirations after training (OR 6.1, [1.54, 24.1]), whereas physicians did not (OR 0.89 [0.36, 2.22]). Training was not associated with a change in referrals to general surgery. Referral appropriateness, pre-training readiness to change, and previous training in breast mass aspiration were not assessed. DISCUSSION: Attempts to aspirate breast masses may increase after CME training. Individual training may be more effective than group training in increasing the likelihood of attempted aspirations.     

Clinicians' opinions on new vaccination programs implementation

In Canada, several new vaccines were recently approved for clinical use or are expected to be soon. Decision-makers are faced with the choice whether or not to include these vaccines in publicly funded vaccination programs. The aim of this study was to assess Canadian pediatricians' and family physicians' opinions regarding 7 new vaccines, and perceived priority for the introduction of new programs. A self-administered, anonymous, mail-based questionnaire was sent during fall 2009 to a random sample of 1182 family physicians and to all 1852 Canadian pediatricians. Responses to 8 statements regarding frequency and severity of the diseases, efficacy and safety of the vaccines as well as feasibility of immunization programs were used to calculate priority scores to rank the 7 potential new vaccination programs (calculated scores ranging from 0 to 100). Overall response rate was 43%. The majority of respondents perceived the health and economic burden of diseases prevented by the seven new vaccines as important and considered new vaccines to be safe and effective. More than 90% of physicians strongly agreed or agreed that the new vaccines would be or are currently well accepted by the public and by the health professionals who administer vaccines, except for the HPV and rotavirus vaccines (respectively 30% and 29% strongly agreed or agreed). Mean priority scores were: 77.4 out of 100 for the measles, mumps, rubella and varicella (MMRV) combined vaccine; 75.6 for the hexavalent (DTaP-IPV-Hib-HBV) vaccine; 73.1 for the new pneumococcal conjugate vaccines; 69.8 for the meningococcal ACYW135; 68.9 for the combined hepatitis A and B; 63.5 for the human papillomavirus vaccine and 56.9 for the rotavirus vaccine. Health professionals' opinion is an important element to consider in the decision-making process regarding implementation of new immunization programs. Without health professional support, the introduction of a new vaccination program may be unsuccessful. In this study, the MMRV and the hexavalent (DTaP-IPV-Hib-HBV) vaccines received the highest ratings.     

Assessment of urgent and ongoing contraceptive needs in an OB/GYN urgent care setting

BACKGROUND: The potential that ongoing contraception and emergency contraception (EC) offer to reduce unplanned pregnancy and abortion is diminished by many barriers. Even when women seek care, their acute needs for those interventions may not be assessed. STUDY DESIGN: This is a retrospective chart review of charts of women potentially at risk for unplanned pregnancy who were provided care in an OB-GYN urgent care clinic in a tertiary care, training hospital. Information was collected about the patient's age group, her presenting complaint, the specialty of the resident who saw her and whether or not her needs for EC and ongoing contraception were assessed and/or met. RESULTS: Charts of 1006 visits were assessed; the visits of 666 potentially at-risk women were included. Slightly more than one third (37.5%) of women were asked about contraception. Only 11% of women were asked about recent unprotected intercourse; 20% of women with recent unprotected intercourse were given EC. CONCLUSIONS: Even in centers dedicated to women's reproductive health, the acute need for fertility control and EC is not adequately assessed. Many opportunities to reduce unintended pregnancy are missed.     

Impact of a clinical interventions bundle on uptake of HPV vaccine at an OB/GYN clinic

IntroductionHPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population.ObjectivesTo determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women.MethodsFrom 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients’ charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11–26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends.ResultsThere were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women.ConclusionsImplementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.     

Pap Smear and Mammogram Screening Rates in a Refugee and General OB/GYN Clinic: A Retrospective Review

Journal of Immigrant and Minority Health - Although multiple studies have shown that resettled refugee women are less likely to receive preventative cancer screenings like pap smears and...     

Completing the Maternal Care Team: OB/GYN Expertise at Rural District Hospitals in Ghana,a Qualitative Study

Introduction To provide a qualitative perspective on the changes that occurred after newly placed OB/GYNs began working at district hospitals in Ashanti, Ghana. Methods Structured interviews of healthcare professionals were conducted at eight district hospitals located throughout the Ashanti district of Ghana, four with and four without a full-time OB/GYN on staff. Individuals interviewed include: medical superintendents, medical officers, district hospital administrators, OB/GYNs (where applicable), and nurse-midwives. Interviews were transcribed verbatim and content analysis was performed to identify common themes. Characteristics quotes were identified to illustrate principal interview themes. Quotes were verified in context by researchers for accuracy. Results Interviews with providers revealed four areas most impacted by an OB/GYN’s leadership and expertise at district hospitals: patient referral patterns, obstetric protocol and training, facility management and organization, and hospital reputation. Discussion OB/GYNs are uniquely positioned to add clinical capacity and care quality to established maternal care teams at district hospitals–empowering district hospitals as reliable care centers throughout rural Ghana for women’s health. Coordinated efforts between government, donors and OBGYN training institutions to provide complete obstetric teams is the next step to achieve the global goal of eliminating preventable maternal mortality by 2030.     

Setting priorities for new vaccination programs by using public health officers and immunization managers opinions

The objective of this work was to assess the opinions of public health professionals (PHPs) about routinely recommended and new vaccines, and to evaluate the feasibility of using a modified Basic Priority Rating System (BPRS) approach to prioritize new immunization programs. One hundred and thirty six PHPs were invited to participate in the survey and 101 responded. Ninty-eight percent of respondents agreed that "recommended vaccines are very useful" (mean score=9.5 out of 10). Between 47% and 100% of respondents agreed with statements about usefulness, safety, effectiveness and acceptability of seven new vaccines (mean scores 5.7-9.7). The highest BPRS scores were observed for MMRV (7.3), DTaP-IPV-HBV-Hib (7.0), and conjugate ACYW-135 (5.4), followed by HPV (4.8), HAV (4.4), rotavirus (1.6) and zoster vaccine (1.5%). The results demonstrate that PHPs perceive presently recommended vaccines as very useful tools in infection prevention. On the other hand, the perceived usefulness, safety, effectiveness, and acceptability of new vaccines are heterogeneous. This heterogeneity is indicative of the complexity of decision-making around implementation of new immunization programs and the need for tools facilitating program prioritization. The modified BPRS approach using survey responses to five statements on program usefulness, vaccine safety, effectiveness, and acceptance by vaccinators and the population is a simple, feasible and inexpensive method of prioritizing new immunization programs. The method we propose is flexible in choosing target groups and allows a large number of professionals to be involved in the decision-making process about new immunization programs.