A population-based study of US women’s preferred versus usual sources of reproductive health care - 22/05/15

Doi : 10.1016/j.ajog.2015.04.025

Kelli Stidham Hall, PhD, MS ^b,^⁎ , Elizabeth W. Patton, MD, MPhil ^c, Halley P. Crissman, MPH ^d, Melissa K. Zochowski, MBA ^a, Vanessa K. Dalton, MD, MPH ^e
^a Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
^b Institute for Social Research, University of Michigan, Ann Arbor, MI
^c Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI
^d School of Medicine, University of Michigan, Ann Arbor, MI
^e Department of Obstetrics and Gynecology, Program on Women’s Health Care Effectiveness Research, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI

^∗Corresponding author: Kelli Hall, PhD, MS.

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Abstract

Objective

We characterized US women’s preferred and usual sources of reproductive health care.

Study Design

Data were drawn from the Women’s Health Care Experiences and Preferences Study, an Internet survey of 1078 women aged 18–55 years randomly sampled from a national probability panel. We described and compared women’s preferred and usual sources of care (women’s health specialists including obstetricians-gynecologists and family-planning clinics, primary care, other) for Papanicolaou/pelvic examination, contraception, and sexually transmitted infection (STI) services using χ², logistic regression, and kappa statistics.

Results

Among women reporting health service utilization (n = 984, 92% overall; 77% Papanicolaou/pelvic; 33% contraception; 8% STI), women’s health specialists were the most used sources of care for Papanicolaou/pelvic (68%), contraception (74%), and STI (75%) services. Women’s health specialists were also the most preferred care sources for Papanicolaou/pelvic (68%), contraception (49%), and STI (35%) services, whereas the remainder of women preferred primary care/other sources or not to get care. Differences in preferred and usual care sources were noted across sociodemographic groups, including insurance status and income level (P < .05). Preference for women’s health specialists was the strongest predictor of women’s health specialist utilization for Papanicolaou/pelvic (adjusted odds ratio, 48.8; 95% confidence interval, 25.9–91.8; P < .001) and contraceptive (adjusted odds ratio, 194.5; 95% confidence interval, 42.3–894.6; P < .001) services. Agreement between preferred and usual-care sources was high for Papanicolaou/pelvic (85%, kappa, 0.63) and contraception (86%; kappa, 0.64) services; disagreement (range, 15–22%) was associated with insurance, employment, income, race, and religion (P < .05).

Conclusion

Women’s preferences for and use of women’s health specialists for reproductive health care has implications for efforts to define the role of obstetricians-gynecologists and family planning clinics in current health systems.

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Key words : health service preferences, reproductive health care, women’s health service utilization

Plan

Materials and Methods

Study design and sample

Measures

Statistical analysis

Results

Sample characteristics (n = 984)

Use of reproductive health services

Preferences for reproductive health care

Associations and agreement between usual and preferred sources of care

Comment

Clinical implications

	This work was supported by Eunice Kennedy ShriverNational Institute of Child Health and Human Development Building Interdisciplinary Careers in Women’s Health K-12 Career Development grant K12HD001438 (K.S.H.), the Robert Wood Johnson Clinical Scholars Program/Department of Veterans Affairs (E.W.P.), and the Program on Women’s Health Care Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan School of Medicine (V.K.D.).
	The authors report no conflict of interest.
	The source of the work was the Women’s Health Care Experiences and Preferences Study, a population-based survey administered August 2013 using the GfK (formerly Knowledge Networks) nationally representative probability panel.
	Cite this article as: Stidham Hall K, Patton EW, Crissman HP, et al. A population-based study of US women’s preferred versus usual sources of reproductive health care. Am J Obstet Gynecol 2015;213:xx-xx.