Britta L. Anderson

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.

Factors Associated With Physicians' Reliance on Pharmaceutical Sales Representatives

Purpose To examine relationships between pharmaceutical representatives and obstetrician-gynecologists and identify factors associated with self-reported reliance on representatives when making prescribing decisions. Method In 2006-2007, questionnaires were mailed to 515 randomly selected physicians in the American College of Obstetricians and Gynecologists’ Collaborative Ambulatory Research Network. Participants were asked about the information sources used when deciding to prescribe a new drug, interactions with sales representatives, views of representatives’ value, and guidelines they had read on appropriate industry interactions. Results Two hundred fifty-one completed questionnaires (49%) were returned. Seventy-six percent of participants see sales representatives’ information as at least somewhat valuable. Twenty-nine percent use representatives often or almost always when deciding whether to prescribe a new drug; 44% use them sometimes. Physicians in private practice are more likely than those in university hospitals to interact with, value, and rely on representatives; community hospital physicians tend to fall in the middle. Gender and age are not associated with industry interaction. Dispensing samples is associated with increased reliance on representatives when making prescribing decisions, beyond what is predicted by a physician’s own beliefs about the value of representatives’ information. Reading guidelines on physician-industry interaction is not associated with less reliance on representatives after controlling for practice setting. Conclusions Physicians’ interactions with industry and their familiarity with guidelines vary by practice setting, perhaps because of more restrictive policies in university settings, professional isolation of private practice, or differences in social norms. Prescribing samples may be associated with physicians’ use of information from sales representatives more than is merited by the physicians’ own beliefs about the value of pharmaceutical representatives.

Obstetrician/Gynecologists' Knowledge, Attitudes, and Practices regarding Prevention of Infections in Pregnancy

BACKGROUND Maternal infection during pregnancy is a well-recognized cause of birth defects and developmental disabilities, as well as an important contributor to other adverse pregnancy outcomes. The objective of the present survey was to gain information about the knowledge, attitudes, and practices of obstetrician/gynecologists regarding prevention of infections during pregnancy. METHODS A survey was mailed to 606 Collaborative Ambulatory Research Network (CARN) members of the American College of Obstetricians and Gynecologists (ACOG) (approximately 2% of membership). CARN members were sampled to demographically represent ACOG. RESULTS Of the 606 eligible respondents, surveys were received from 305 (response rate: 50%). Most obstetrician/gynecologists knew that specific actions by pregnant women could reduce the risk of infection. Seventy-nine to eighty-eight percent reported counseling pregnant women about preventing infection from Toxoplasma gondii, hepatitis B virus, and influenza, 50%-68% about varicella-zoster virus, Listeria monocytogenes, and Parvovirus B19, and <50% about cytomegalovirus, Bordetella pertussis, and lymphocytic choriomeningitis virus. The majority reported time constraints were a barrier to counseling, although most reported educational materials would be helpful. CONCLUSIONS Knowledge was accurate and preventive counseling was appropriate for some infections, but for others it could be improved. Further studies are needed to identify strategies to increase preventive counseling.

Outlook for the future of the obstetrician-gynecologist workforce.

OBJECTIVE The objective of the study was to assess the future physician workforce with a sample of obstetrician-gynecologists. STUDY DESIGN Two separate surveys regarding career satisfaction and retirement plans were sent to random samples of obstetrician-gynecologists under age 50 years (n = 2,000) and over the age of 50 (n = 2,100). RESULTS Obstetrician-gynecologists over the age of 50 years who were working part time or were female were more satisfied than those working full time or were male. Obstetrician-gynecologists (under and over age 50 years) who were concerned about liability and unable to balance their work and personal lives were more dissatisfied. Obstetrician-gynecologists retired earlier than planned because of rising malpractice costs and later than planned because of high career satisfaction. CONCLUSION Low career satisfaction may be adding to the already shrinking physician workforce. Offering part-time work opportunities and alleviating liability concerns may increase career satisfaction and help to combat a future of the physician workforce shortage.

Screening practices and attitudes of obstetricians-gynecologists toward new and emerging tobacco products.

OBJECTIVE We examined screening practices and attitudes of obstetricians-gynecologists toward the use of noncombustible tobacco products (chewing tobacco, snuff/snus, electronic cigarettes, and dissolvables) during pregnancy. STUDY DESIGN The authors mailed a survey in 2012 to 1024 members of the American College of Obstetricians and Gynecologists, including Collaborative Ambulatory Research Network (CARN) and non-CARN members. Stratified random selection was used to generate CARN and non-CARN samples. RESULTS Response rates were 52% and 31% for CARN and non-CARN members, respectively. Of 252 total eligible respondents (those currently providing obstetrics care) 53% reported screening pregnant women at intake for noncombustible tobacco product use all or some of the time, and 40% reported none of the time. Respondents who reported that noncombustible products have adverse health effects during pregnancy, but are safer than cigarettes, ranged from 20.2% (dissolvables) to 29% (electronic cigarettes) and that the health effects are the same as those of cigarettes from 13.5% (electronic cigarettes) to 53.6% (chewing tobacco). Approximately 14% reported that electronic cigarettes have no adverse health effects; <1% reported no health effects for the remaining products. Two-thirds of the respondents wanted to know more about the potential health effects of noncombustible tobacco products; only 5% believed themselves to be fully informed. CONCLUSION A large proportion of obstetrician-gynecologists reported never or inconsistently screening their pregnant patients for the use of noncombustible tobacco products. Responses regarding the harms of these products relative to cigarettes were mixed and most respondents wanted more information. Development and dissemination of guidance for providers is needed to improve decision-making regarding noncombustible tobacco products.

A First Look at Chorioamnionitis Management Practice Variation among US Obstetricians

Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.

Changes in and Current Status of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Regarding Immunization

Vaccines are important tools for disease prevention and, in obstetric patients, to prevent transmission to infants. Obstetrician-gynecologists are well situated to screen for immunization status of women of child-bearing age and to provide appropriate vaccinations. A series of research investigated obstetrician-gynecologists’ beliefs, practices, and knowledge regarding immunization. Surveys were sent out in 2007 to Fellows of the American College of Obstetricians and Gynecologists. Most obstetrician-gynecologists viewed screening for vaccine-preventable diseases to be within their professional role, and a majority administers at least some vaccines. Over half agreed financial factors (eg, inadequate reimbursement, cost of storing vaccines) were barriers to vaccine administration. Other perceived barriers were a concern over safety of vaccinations during pregnancy and a view that administering vaccines was not part of their usual practice. They were also concerned about their level of training. A majority believed their immunization training was less than adequate, and believed their practice would benefit from continuing medical education courses. One study identified changes in Michigan obstetrician-gynecologists’ attitudes, knowledge and practices since 2000. More Michigan ob-gyns are assessing vaccination needs, viewing this as part of their professional purview, and, in general, their knowledge of vaccine recommendations has improved. Concerns over the safety of vaccines in pregnancy as well as financial burdens of immunization have increased. Immunization is an important part of womens health care and has been, at least partially, incorporated into obstetrician-gynecologist practice. Financial burdens and physician concerns over training remain barriers to vaccine administration. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this educational activity, the participant should be better able to modify prescribing practices to increase the rates of appropriate use of vaccinations in the care of women, identify and then resolve barriers in practice to proper administration of vaccines, and recall the immunizations recommended for pregnant women.

Surveying ourselves: examining the use of a web-based approach for a physician survey.

A survey was distributed, using a sequential mixed-mode approach, to a national sample of obstetrician–gynecologists. Differences between responses to the web-based mode and the on-paper mode were compared to determine if there were systematic differences between respondents. Only two differences in respondents between the two modes were identified. University-based physicians were more likely to complete the web-based mode than private practice physicians. Mail respondents reported a greater volume of endometrial ablations compared to online respondents. The web-based mode had better data quality than the paper-based mailed mode in terms of less missing and inappropriate responses. Together, these findings suggest that, although a few differences were identified, the web-based survey mode attained adequate representativeness and improved data quality. Given the metrics examined for this study, exclusive use of web-based data collection may be appropriate for physician surveys with a minimal reduction in sample coverage and without a reduction in data quality.

Survey of obstetric and gynecologic hospitalists and laborists

OBJECTIVE The objective of the study was to obtain descriptive information about obstetricians/gynecologists who currently are practicing as hospitalists or laborists. STUDY DESIGN A survey was emailed to all actively practicing member Fellows of the American College of Obstetricians and Gynecologists in April 2009. A second emailing of the survey was sent in May 2009. RESULTS Obstetrician/gynecologist hospitalists and laborists are significantly younger than the rest of the obstetrician/gynecologist sample by age and years in residency and have a high rate of career satisfaction. There was a great deal of variation in work schedules and compensation of the respondents. CONCLUSION We analyzed the rapidly growing hospitalist/laborist model of care within the obstetrician/gynecologist specialty. The laborists and hospitalists model provides an alternative type of practice for obstetricians/gynecologists, and it is associated with high career satisfaction. It is important that we continue to monitor the needs of this burgeoning field of clinical practice.

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. &khgr;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.