Advertisement

The Role of the Obstetrician/Gynecologist in the Prevention of Cardiovascular Disease in Women

      Abstract

      Purpose

      A qualitative study was conducted to understand the current and potential role of the community obstetrician/gynecologist (OBGYN) in risk factor screening and prevention of cardiovascular disease.

      Methods

      A total of four focus group discussions were conducted among 46 OBGYN residents and practicing physicians in the mid-Atlantic region.

      Main Findings

      Five main thematic areas were identified including scope of practice, professional knowledge and skills in non-reproductive care, potential for liability, logistical and structural barriers, medical practice community, and support for collaborative care. There were no differences between residents and those in practice within and between cities. Comprehensive care was most often defined as excluding chronic medical care issues and most likely as focusing on screening and referring women. The OBGYN recognized their common role as the exclusive clinician for women was, in part, a consequence of patients’ nonadherence with primary care referrals. Barriers and strategies were identified within each thematic area.

      Conclusion

      Additional training, development of referral networks, and access to local and practice specific data are needed to support an increased role for the OBGYN in the prevention of cardiovascular disease in women. Establishment of evidence-based screening and referral recommendations, specific to women across the age spectrum, may enable clinicians to capitalize on this important prevention opportunity. Longer term, and in concert with health care reform, a critical evaluation of the woman’s place in the center of her medical home, rather than any one site, may yield improvements in health outcomes for women.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abbo E.D.
        • Zhang Q.
        • Selder M.
        • Huang E.S.
        The increasing number of clinical items addressed during the time of adult primary care visits.
        Journal of General Internal Medicine. 2008; 23: 2058-2065
        • Barnhart J.
        • Lewis V.
        • Houghton J.L.
        • Charney P.
        Physician knowledge levels and barriers to coronary risk prevention in women: Survey results from the Women and Heart Disease Physician Education Initiative.
        Womens Health Issues. 2007; 17: 93-100
        • Chen L.M.
        • Farwell W.R.
        • Jha A.K.
        Primary care visit duration and quality: Does good care take longer?.
        Archives of Internal Medicine. 2009; 169: 1866-1872
        • Coleman V.H.
        • Laube D.W.
        • Hale R.W.
        • Williams S.B.
        • Power M.L.
        • Schulkin J.
        Obstetrician-gynecologists and primary care: Training during obstetrics-gynecology residency and current practice patterns.
        Academic Medicine. 2007; 82: 602-607
        • U.S. Department of Health and Human Services, Health Resources and Services Administration
        Women's Health USA 2008.
        U.S. Department of Health and Human Services, Rockville, Maryland2008
        • Henderson J.T.
        • Weisman C.S.
        • Grason H.
        Are two doctors better than one? Women’s physician use and appropriate care.
        Womens Health Issues. 2002; 12: 138-149
        • Lloyd-Jones D.
        • Adams R.
        • Carnethon M.
        • De Simone G.
        • Ferguson T.B.
        • Flegal K.
        • et al.
        Heart disease and stroke statistics—2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2009; 119: e21-e181
        • Mikkola T.S.
        Cardiovascular risk assessment in postmenopausal women: The role of the gynecologist.
        Climacteric. 2009; 12: 58-61
        • Mosca L.
        • Linfante A.H.
        • Benjamin E.J.
        • Berra K.
        • Hayes S.N.
        • Walsh B.W.
        • et al.
        National study of physician awareness and adherence to cardiovascular disease prevention guidelines.
        Circulation. 2005; 111: 499-510
        • Mosca L.
        • Mochari H.
        • Christian A.
        • Berra K.
        • Taubert K.
        • Mills T.
        • Burdick K.A.
        • et al.
        National study of women’s awareness, preventive action, and barriers to cardiovascular health.
        Circulation. 2006; 113: 525-534
        • Pollak K.I.
        • Krause K.M.
        • Yarnall K.S.
        • Gradison M.
        • Michener J.L.
        • Østybe T.
        Estimated time spent on preventive services by primary care physicians.
        BMC Health Services Research. 2008; 8: 245
        • Power M.L.
        • Cogswell M.E.
        • Schulkin J.
        Obesity prevention and treatment practices of U.S. obstetrician-gynecologists.
        Obstetrics and Gynecology. 2006; 108: 961-968
        • Salganicoff A.
        • Ranji U.
        • Wynn R.
        Women and health care: A national survey.
        Kaiser Family Foundation, Menlo Park, CA2005
        • Scholle S.H.
        • Kelleher K.
        Assessing primary care performance in an obstetrics/gynecology clinic.
        Women and Health. 2003; 37: 15-30
        • Stovall D.W.
        • Loveless M.B.
        • Walden N.A.
        • Karjane N.
        • Cohen S.A.
        Primary and preventive healthcare in obstetrics and gynecology: A study of practice patterns in the mid-Atlantic region.
        Journal of Womens Health. 2007; 16: 134-138
        • Whitlock E.P.
        • Williams S.B.
        The primary prevention of heart disease in women through health behavior change promotion in primary care.
        Womens Health Issues. 2003; 13: 122-141

      Biography

      Deborah B. Ehrenthal, MD, is Clinical Assistant Professor of Medicine, Thomas Jefferson University, and Medical Director of Women’s Health Programs at Christiana Care Health System. Her research interests include the health and health care of reproductive age women.

      Biography

      Ana E. Núñez, MD, MPH, is an Associate Professor of Medicine at Drexel University College of Medicine in Philadelphia, Pennsylvania. Her research interests include a focus on medical education promoting behavior change and in community participatory health services research.

      Biography

      Elizabeth O’Neill, BA, is Project Director for the Community Center of Excellence in Women’s Health and The Heart Truth Delaware at Christiana Care Health System. Her interests include building community partnerships to improve the health of medically underserved women.

      Biography

      Candace Robertson-James, MPH, is Research Manager of the Women’s Health Education Program, Drexel University College of Medicine. Her research expertise and interests include women and minority health issues and community-based participatory research.

      Biography

      Sonya Feinberg Addo, MPH, is the Deputy Project Director of The Heart Truth Delaware at Christiana Care Health System. Her interests include reproductive health education, provider education, and training health care providers in techniques to promote behavior change.

      Biography

      Ashley Stewart, MS, CHES, is a Health Educator in the Department of Obstetrics and Gynecology at Christiana Care Health System. Her interests include women’s health education and prevention of adolescent risk behaviors.