Obstetricians and gynecologists' opinions about the Affordable Care Act and their expectations about how it will impact their practice.

As the primary healthcare providers for women, obstetrician-gynecologists' (OB/GYNs) experiences with and opinions about the Affordable Care Act (ACA) are important to understand. An online survey was sent to 1000 randomly selected OB/GYNs who were members of the American College of Obstetricians and Gynecologists (ACOG) in 2014. Of those, 523 opened the email and 163 responded (31% participation rate). Data were collected August 2014-October 2014 and analyzed in 2015-2016. Support for the ACA was widely distributed, with the largest subset of the sample (about 21%) in the "very supportive" category. Opinions of the ACA were more supportive than they were in a previous study conducted in 2011. When given a list of possible positive and negative impacts of the ACA on their practice, roughly 1 in 5 reported that the ACA increased work-related stress (28%), decreased total profits (22%), and lowered career satisfaction (22%), whereas 8.6% reported that the ACA increased quality of care. Around half of the providers thought that their newly insured patients would have the same level of education (42%) and numeric ability (55%) as their current patients. Almost all respondents (87%) indicated that it is at least slightly important for patients to understand their numeric likelihood of risk (such as numeric risk information from medications, treatments, and other procedures you might prescribe) -31% think it is extremely important and 44% think it is moderately important.

Screening and Treatment for Iron Deficiency Anemia in Women: Results of a Survey of Obstetrician-Gynecologists.

Objective To better understand the knowledge, attitudes and practices of obstetrician-gynecologists with respect to screening and treatment for iron deficiency anemia (IDA). Methods A total of 1,200 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, screening and treatment practices for IDA, and general knowledge about IDA and its risk factors. Results Overall response rate was 42.4%. Thirty-eight percent of respondents screen non-pregnant patients regularly, based on risk factors; 30.5% screen only when symptoms of anemia are present. For pregnant patients, 50.0% of respondents screen patients at their initial visit, while 46.2% screen every trimester. Sixty-one percent of respondents supplement pregnant patients when there is laboratory evidence of anemia; 31.6% supplement all pregnant patients. Forty-two percent of respondents screen post-partum patients based on their risk factors for IDA. However, when asked to identify risk factors for post-partum anemia, slightly more than half of respondents correctly identified young age and income level as risk factors for post-partum anemia; only 18.9% correctly identified pre-pregnancy obesity as a risk factor. Conclusion There are opportunities for increased education on IDA for obstetrician-gynecologists, specifically with respect to risk factors. There also appears to be substantial practice variance regarding screening and supplementation for IDA, which may correspond to variability in professional guidelines. Increased education on IDA, especially the importance of sociodemographic factors, and further research and effort to standardize guidelines is needed.

The Double Disparity Facing Rural Local Health Departments.

Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

Comparing physicians personal prevention practices and their recommendations to patients.

BACKGROUND: Hypothetical choice studies suggest that physicians often take more risk for themselves than on their patient's behalf. OBJECTIVE: To examine if physicians recommend more screening tests than they personally undergo in the real-world context of breast cancer screening. DESIGN: Within-subjects survey. PARTICIPANTS: A national sample of female obstetricians and gynecologists (N = 135, response rate 54%) from the United States. In total, they provided breast care to approximately 2,800 patients per week. MEASURES: Personal usage history and patient recommendations regarding mammography screening and breast self-examination, a measure of defensive medicine practices. RESULTS: Across age groups, female physicians were more likely to recommend mammography screening than to have performed the procedure in the past 5 years (86% vs. 81%, p = .10). In respondents aged 40-49 this difference was significant (91% vs. 82%, p < .05), whereas no differences were detected for younger or older physicians. Among respondents in their 40s, 18% had undergone annual screenings in the past 5 years, compared to 48% of their colleagues above 50. Respondents were as likely to practice breast self-examination (98%) as to recommend it (93%), a pattern that was consistent across age groups. A logistic regression model of personal use of mammography significantly predicted recommending the procedure to patients (OR = 15.29, p = .001). Similarly, number of breast self-examinations performed over the past 2 years positively predicted patient recommendations of the procedure (OR = 1.31, p < .001). CONCLUSIONS: Obstetricians and gynecologists tended to recommend early mammography screening to their patients, though their personal practices indicated later start than their own recommendations and lower frequency of screening than peers in recent studies have recommended.

Obstetrician-Gynecologists' Practices, Statistical Literacy, and Risk Communication with Regard to Sexually Transmitted Infections.

In order to best care for women, obstetrician-gynecologists (ob-gyns) must be able to diagnose and treat sexually transmitted infections (STIs), as well as effectively communicate risks regarding STIs. This article provides a narrative review of studies primarily conducted by the Research Department at the American College of Obstetricians and Gynecologists, about missed opportunities for STI risk communication. Missed opportunities include the omission or partial completion of STI risk assessment and counseling, failure to offer screening or testing, lack of follow-up on STI testing/vaccination refusals, and a failure to comply with existing guidelines. We also discuss knowledge level, time constraints, and gaps in statistical literacy as barriers to STI communication. The aim of this article is to highlight common barriers to risk communication, discuss their potential impact, and suggest means by which these obstacles can be addressed. Future directions for training, education, and research are discussed.

Survey of obstetrician-gynecologists in the United States about toxoplasmosis: 2012 update.

PURPOSE: Toxoplasmosis, caused by the parasite Toxoplasma gondii, can have serious impacts on fetal development in the setting of acute maternal primary infection. The American College of Obstetricians and Gynecologists (ACOG) sought to determine current knowledge, practices, opinions, and educational preferences regarding T. gondii infection in pregnancy among ACOG members practicing prenatal care. METHODS: ACOG sent a survey to 1,056 members chosen by stratified random sampling from membership lists, including 370 participants and 686 non-participants in the Collaborative Ambulatory Research Network (CARN). Mailings were sent up to four times to nonresponders. RESULTS: Survey minimum response rates were 40.3% (CARN) and 19.7% (non-CARN); response rates adjusted for imputed non-eligibility were 59.7% (CARN) and 22.6% (non-CARN). Among providers, 80.2% had diagnosed no acute maternal T. gondii infections in the past 5 years, 12.7% correctly identified the screening role of the Toxoplasma avidity test, 42.6% performed serologic T. gondii screening for at least some asymptomatic pregnant women, and 62.1% of those who so did used appropriate approaches. Providers in the northeastern United States were 2.02 times more likely to routinely screen than those in the west (p = 0.025) and female providers were 1.48 times more likely than male providers (p = 0.047). The potential educational interventions considered useful by the most practitioners were updated ACOG guidelines on screening (81.4%) and management (71.7%) for acute T. gondii infection in pregnancy. CONCLUSIONS: ACOG members would benefit from educational efforts targeted at risk factor counseling and screening approaches.

Obstetrician-gynecologists' knowledge of sickle cell disease screening and management.

BACKGROUND: Although obstetrician/gynecologists (OB/GYNs) play an important role in sickle cell disease (SCD) screening and patient care, there is little information on knowledge of SCD or sickle cell trait (SCT) or related practices in this provider group. Our objective was to assess SCD screening and prenatal management practices among OB/GYNs. METHODS: Twelve hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (the College)a were invited to complete a mailed survey, of which half (n = 600) belonged to the Collaborative Ambulatory Research Network.b Participants answered questions regarding appropriate target patient groups for prenatal SCD screening, folic acid requirements, practice behaviors and adequacy of their medical school and residency training. RESULTS: A total of 338 CARN members (56.3%) and 165 non-CARN members (27.5%) returned a survey. Of the 503 responders, 382 provided obstetric services and were included in the analyses. Forty percent of these respondents (n = 153) reported seeing at least 1 patient with SCD in the last year. Of these, 97.4% reported regularly screening people of African descent for SCD or SCT, whereas 52.9% reported regularly screening people of Mediterranean descent and 30.1% reported regularly screening people of Asian descent. Only 56.2% knew the correct recommended daily dose of folic acid for pregnant women with SCD. The proportion of respondents that rated training on SCD screening, assessment and treatment as barely adequate or inadequate ranged from 19.7% to 39.3%. CONCLUSIONS: The practice of many OB/GYNs who care for patients with SCD are not consistent with the College Practice Guidelines on the screening of certain target groups and on folic acid supplementation. There may be an opportunity to improve this knowledge gap through enhanced medical education.

Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.

OBJECTIVES: Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined obstetrician-gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception. DESIGN: A survey questionnaire was sent to a computer-generated sample of 3000 fellows who were reflective of the American College of Obstetricians and Gynecologists (College) membership. RESULTS: After exclusions from the 1552 returned surveys (51.7% response rate), 1150 eligible questionnaires were analyzed. Almost all obstetrician-gynecologists (95.8%) reported providing IUDs, but only 66.8% considered nulliparous women, and 43.0% considered adolescents appropriate candidates. Even among obstetrician-gynecologists who recalled reading a College publication about IUDs, only 78.0% and 45.0% considered nulliparous women and adolescents appropriate candidates, respectively. Few respondents (16.1%) had recommended the copper IUD as emergency contraception, and only 73.9% agreed that the copper IUD could be used as emergency contraception. A total of 67.3% of respondents agreed that an IUD can be inserted immediately after an abortion or miscarriage. Fewer (43.5%) agreed that an IUD can be inserted immediately postpartum, and very few provide these services (11.4% and 7.2%, respectively). Staying informed about practice recommendations for long-acting reversible contraception was associated with broader provision of IUDs. CONCLUSIONS: Although most obstetrician-gynecologists offer IUDs, many exclude appropriate candidates for IUD use, both for emergency contraception and for long-term use, despite evidence-based recommendations. IMPLICATIONS: This study shows that obstetrician-gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.

Obstetrician-gynecologists and contraception: long-acting reversible contraception practices and education.

OBJECTIVES: Long-acting reversible contraception (LARC) - the copper and levonorgestrel intrauterine devices (IUDs) and the single-rod implant - are safe and effective but account for a small proportion of contraceptive use by US women. This study examined obstetrician-gynecologists' knowledge, training, practice and beliefs regarding LARC methods. DESIGN: A survey questionnaire was mailed to 3000 Fellows of the American College of Obstetricians and Gynecologists. After exclusions, 1221 eligible questionnaires were analyzed (45.8% response rate, accounting for exclusions). RESULTS: Almost all obstetrician-gynecologists reported providing IUDs (95.8%). Most obstetrician-gynecologists reported requiring two or more visits for IUD insertion (86.9%). Respondents that reported IUD insertion in a single visit reported inserting a greater number of IUDs in the last year. About half reported offering the single-rod implant (51.3%). A total of 92.0% reported residency training on IUDs, and 50.8% reported residency training on implants. Residency training and physician age correlated with the number of IUDs inserted in the past year. A total of 59.6% indicated receiving continuing education on at least one LARC method in the past 2years. Recent continuing education was most strongly associated with implant insertion, and 31.7% of respondents cited lack of insertion training as a barrier. CONCLUSIONS: Barriers to LARC provision could be reduced if more obstetrician-gynecologists received implant training and provided same-day IUD insertion. Continuing education will likely increase implant provision. IMPLICATIONS: This study shows that obstetrician-gynecologists generally offer IUDs, but fewer offer the single-rod contraceptive implant. Recent continuing education strongly predicted whether obstetrician-gynecologists inserted implants and was also associated with other practices that encourage LARC use.

How do physicians provide statistical information about antidepressants to hypothetical patients?

BACKGROUND: Little is known about how physicians provide statistical information to patients, which is important for informed consent. METHODS: In a survey, obstetricians and gynecologists (N = 142) received statistical information about the benefit and side effects of an antidepressant. They received information in various formats, including event rates (antidepressant v. placebo), absolute risks, and relative risks. Participants had to imagine 2 hypothetical patients, 1 for whom they believed the drug to be safe and effective and 1 for whom they did not, and select the information they would give those patients. We assessed whether the information they selected for each patient was complete, transparent, interpretable, or persuasive (i.e., to nudge patients toward a particular option) and compared physicians who gave both patients the same information with those who gave both patients different information. RESULTS: A similar proportion of physicians (roughly 25% each) selected information that was 1) complete and transparent, 2) complete but not transparent, 3) not interpretable for the patient because necessary comparative information was missing, or 4) suited for nudging. Physicians who gave both patients the same information (61% of physicians) more often selected at least complete information, even if it was often not transparent. Physicians who gave both patients different information (39% of physicians), in contrast, more often selected information that was suited for nudging in line with the belief they were asked to imagine. A limitation is that scenarios were hypothetical. CONCLUSIONS: Most physicians did not provide complete and transparent information. Clinicians who presented consistent information to different patients tended to present complete information, whereas those who varied what information they chose to present appeared more prone to nudging.

Smoking cessation during pregnancy and postpartum: practice patterns among obstetrician-gynecologists.

OBJECTIVES: To assess current obstetrician-gynecologist (ob-gyn) practice patterns related to the management of and barriers to smoking cessation during pregnancy and postpartum. METHODS: A smoking cessation questionnaire was mailed to 1024 American College of Obstetricians and Gynecologists Fellows in 2012. χ(2) analyses were used to assess for categorical differences between groups, Pearson r was used to conduct correlational analysis, and analysis of variance was used to assess for mean differences between groups. RESULTS: The analyses included 252 practicing ob-gyns who see pregnant patients who returned a completed survey. Ob-gyns estimated that 23% of their patients smoke before pregnancy, 18% smoke during first trimester, 12% during second trimester, and 11% during third trimester. They approximated that 32% quit during pregnancy, but 50% return to smoking postpartum. A large majority of ob-gyns feel that it is important for pregnant and postpartum women to quit smoking, and report asking all pregnant patients about tobacco use at the initial prenatal visit. Fewer ob-gyns follow-up on tobacco use at subsequent visits when the patient has admitted to use at a prior visit. The primary barrier to intervention was reported as time limitations, though other barriers were noted that may be addressable through the provision of additional training and resources offered to physicians. CONCLUSIONS: Compared with findings from a similar study conducted in 1998, physicians are less likely to adhere to the 5 As smoking cessation guideline at present. As we know that brief intervention is effective, it is imperative that we work toward addressing practice gaps and providing additional resources to address the important public health issue of smoking during pregnancy and postpartum.

Obstetrician-gynecologists' knowledge and opinions about the United States Preventive Services Task Force (USPSTF) committee, the Women's Health Amendment, and the Affordable Care Act: national study after the release of the USPSTF 2009 Breast Cancer Screening Recommendation Statement.

OBJECTIVE: Investigate the knowledge and opinions of obstetrician and gynecologists (ob-gyns) regarding the USPSTF committee and statement, and to assess their reactions to healthcare legislation. METHODS: A national cross-sectional survey study of ob-gyns was conducted six months after a controversial USPSTF recommendation statement was released in November 2009. Ob-gyns' opinions about the Women's Health Amendment (WHA) and the Affordable Care Act (ACA) were also assessed. RESULTS: A total of 54% of ob-gyns knew that the USPSTF recommendations do not represent the position of the U.S. government and 40% knew that the USPSTF is not comprised of federal employees. A majority (60%) thought that the USPSTF was influenced by potential costs more than guidelines should be. When examining ob-gyns opinions about new national health policies, 88% support the mammography coverage provided by the WHA but support for the ACA varied. CONCLUSION: This study provides a snapshot of ob-gyns' knowledge and opinions about the USPSTF and breast cancer screening guidelines at a controversial point in time. Our findings are a unique contribution to larger efforts to understand health and political policy as the culture of medicine continues to evolve.

Statistical literacy in obstetricians and gynecologists.

The Obstetrician-Gynecologist Statistical Literacy Questionnaire (OGSLQ) was designed to examine physicians' understanding of various number tasks that are relevant to obstetrician-gynecologists (ob-gyns) practice. Forty-seven percent of the nationally representative, practicing ob-gyns responded. Physicians did poorly on the questions about numerical facts (e.g., number of women living with HIV/AIDS), better on questions about statistical concepts (e.g., incidence, prevalence), and best on questions about numerical relationships (e.g., convert frequency to percentage) with 0%, 7%, 36%, answering all correctly, respectively. Only 19% correctly estimated the number of U.S. women with cancer. Sixty-six percent were able to use sensitivity and specificity to choose a test option. Around 90% could translate between frequency and probability formats. Forty-nine percent of respondents were able to calculate the positive predictive value of a mammography screening test. Physicians lack some understanding of statistical literacy. It is important that we monitor physicians' statistical literacy and provide training to students and physicians.

Challenges in cervical cancer prevention: a survey of U.S. obstetrician-gynecologists.

BACKGROUND: Current cervical cancer prevention recommendations include human papillomavirus (HPV) vaccination, Pap and HPV co-testing, and Pap testing at 3- to 5-year intervals. PURPOSE: To examine attitudes, practice patterns, and barriers related to HPV vaccination and cervical cancer screening guidelines among U.S. obstetrician-gynecologists. METHODS: In 2011-2012, a national sample of members of the American Congress of Obstetricians and Gynecologists responded to a 15-item (some with multiple parts) questionnaire assessing sociodemographic characteristics, clinical practices, and perceived barriers to HPV vaccination and cervical cancer screening. Multivariate logistic regression was used to identify factors associated with guideline adherence. Analyses were conducted in 2012. RESULTS: A total of 366 obstetrician-gynecologists participated. Ninety-two percent of respondents offered HPV vaccination to patients, but only 27% estimated that most eligible patients received vaccination. Parent and patient refusals were commonly cited barriers to HPV vaccination. Approximately half of respondents followed guidelines to begin cervical cancer screening at age 21 years, discontinue screening at age 70 years or after hysterectomy, and appropriately utilize Pap and HPV co-testing. Most physicians continued to recommend annual Paps (74% aged 21-29 years, 53% aged ≥30 years). Physicians felt that patients were uncomfortable with extended screening intervals and were concerned that patients would not come for annual exams without concurrent Paps. Solo practitioners were less likely to follow both vaccination and screening guidelines than those in group practices. CONCLUSIONS: This survey of obstetrician-gynecologists indicates persistent barriers to the adoption of HPV vaccination and cervical cancer screening guidelines. Interventions to promote guideline adherence may help improve the quality of cervical cancer prevention.

Obstetrics and gynecology practices and patient insurance type.

BACKGROUND: Despite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician-gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients. METHODS: A questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network. FINDINGS: A 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance ("private group") and the 105 reported providing care to mostly publicly insured or uninsured patients ("non-private group") were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18. CONCLUSION: Results reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.

Conflicting and changing breast cancer screening recommendations: survey study of a national sample of ob-gyns after the release of the 2009 USPSTF guidelines.

OBJECTIVE: To assess obstetrician-gynecologists' (ob-gyns') use of multiple conflicting guidelines assess after the release of the 2009 U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations. STUDY DESIGN: A nationally representative sample of American College of Obstetricians and Gynecologists (ACOG) Fellows were invited to complete a survey. RESULTS: A total of 235 of 399 ob-gyns responded (59% response rate). Twenty percent and 89% indicated that USPSTF and ACOG guidelines influence their practice, respectively, 84% are influenced by more than one guideline. The plurality of respondents was able to correctly identify ACOG and USPSTF guidelines on 10 of 12 questions. One-third agreed with both ACOG's and USPSTF's recommendations regarding mammography screening for women 40-49 years old. A total of 42% of the sample made at least one change in their practice after the release of the 2009 USPSTF breast cancer screening guidelines. CONCLUSION: Some ob-gyns made changes to their practices after the release of the USPSTF guidelines. When multiple guidelines exist, as in the case with breast cancer screening, physicians utilize multiple, and at times conflicting, guidelines. More research will be needed to better understand the impact (negative or positive) of multiple guidelines on the quality of healthcare.

Statistical literacy of obstetrics-gynecology residents.

BACKGROUND: Residents' ability to interpret statistics is important for scholarly pursuits and understanding evidence-based medicine. Yet there is limited research assessing residents' statistical literacy and their training in statistics. METHODS: In 2011 we surveyed US obstetrics-gynecology residents participating in the Council for Resident Education in Obstetrics and Gynecology In-Training Examination about their statistical literacy and statistical literacy training. RESULTS: Our response rate was 95% (4713 of 4961). About two-thirds (2980 of 4713) of the residents rated their statistical literacy training as adequate. Female respondents were more likely to rate their statistical literacy training poorly, with 25% (897 of 3575) indicating inadequate literacy compared with 17% (141 of 806) of the male respondents (P < .001). Respondents performed poorly on 2 statistical literacy questions, with only 26% (1222 of 4713) correctly answering a positive predictive value question and 42% (1989 of 4173) correctly defining a P value. A total of 51% (2391 of 4713) of respondents reported receiving statistical literacy training through a journal club, 29% (1359 of 4713) said they had informal training, 15% (711 of 4713) said that they had statistical literacy training as part of a course, and 11% (527 of 4713) said that they had no training. CONCLUSIONS: The findings suggest that statistical literacy training for residents could still be improved. A total of 37% (1743 of 4713) of obstetrics-gynecology residents have received no formal statistical literacy training in residency. Fewer residents answered the 2 statistical literacy questions correctly compared with previous studies.

Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists.

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.

What factors influence obstetrician-gynecologists to follow recommended HIV screening and testing guidelines?

BACKGROUND: The purpose of this study was to determine what factors may influence obstetrician-gynecologists' HIV testing practices and to learn more about obstetrician-gynecologists' current HIV screening and testing practices. METHODS: Survey questionnaires were sent to 1200 American College of Obstetricians and Gynecologists (the College) Fellows and Junior Fellows in practice between October 2009 and January 2010. Four hundred of the recipients were members of the Collaborative Ambulatory Research Network (CARN), and 800 recipients were randomly selected from the ACOG Fellows and Junior Fellows in practice. RESULTS: The survey response rate was 62.0% (248 of 400) for CARN and 31.1% (249 of 800) for non-CARN. Nearly 100% (99.7%) of the study sample report recommending HIV testing to all pregnant women at least once during each pregnancy, while reported rates for repeat testing in the third trimester remain low (20.1% for all patients and 42.6% for high-risk patients). Two thirds (66.0%) of respondents recommend labor and delivery testing to women with unknown or undocumented HIV status. Fewer than 22.0% of respondents report routinely recommending HIV screening to all non-pregnant women, citing a low-risk population as the most common reason. State laws and regulations have only moderate influence on obstetrician-gynecologists' HIV testing practice, as do practice type, location, and setting. CONCLUSIONS: The results of this study suggest that the provider's perception about the patients' risk for being infected as well as practice type and location are important factors influencing an obstetrician-gynecologist's decision to screen a nonpregnant woman for HIV.

Well-woman care among obstetrician-gynecologists: opportunity for preconception care.

OBJECTIVE: To describe the practices of obstetrician-gynecologists who provide routine gynecological care and assess the relative importance of well-woman care to their training and practices. METHODS: A questionnaire was mailed to 1000 members of the American College of Obstetricians and Gynecologists, of whom 600 participated in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 57%. Of these, 403 respondents providing routine obstetric and gynecologic care (OB&Gyn) are included. Obstetricians-gynecologists spend the majority of their time on labor/delivery (22%) followed by well-woman care (14%). It was found that 26% of the respondents rarely or never discuss sexual abuse or domestic violence with non-pregnant patients and only 19% always discuss folic acid with non-pregnant patients during well-woman care. Most (71%) say that 50% or more of their pregnant patients initially contact them once they are pregnant. Respondents rated their training in well-woman care least strong of several areas listed. CONCLUSION: Obstetrician-gynecologists devote a substantial proportion of work time to providing well-woman care, though some important topics are not addressed and training in this area was rated least strong.