Women's Preventive Services Research Articles

Current Resources for Evidence‐Based Practice September/October 2012

Screening Women for Intimate Partner Violence In a 2004 United States Preventive Services Task Force (USPSTF) report, researchers found insufficient evidence to support routine screening of women for intimate partner violence (IPV) (U.S. Preventive Services Task Force, 2004). More recent studies included in an updated Evidence Report have prompted important changes in recommendations (Nelson, Bougatsos, & Blazina, 2012). In this most recent update, five key questions guided the systematic review and were informed by 35 studies. The report demonstrated that the use of screening tools for IPV can accurately identify women experiencing IPV (fair to good quality evidence). While results varied by population and type of intervention (fair to good quality evidence), screening women for IPV was found to improve health outcomes by decreasing IPV. While some women may experience discomfort, loss of privacy, and concern about further abuse, in general, IPV screening was found to have minimal adverse effects (fair evidence). Results from this systematic review are congruent with recent recommendations from the Institute of Medicine’s 2011 report on Clinical Preventive Services for Women (National Research Council, 2011) that underscore the importance of screening women for IPV.

Preventive Services for Women Under the Affordable Care Act

Preventive Services for Women Under the Affordable Care Act

Current Resources for Evidence‐Based Practice January/February 2012

The Institute of Medicine Report on Clinical Preventive Services for Women: From Evidence to Policy As a central component of the Affordable Care Act (ACA), new health insurance plans will be required to cover preventive health services without cost sharing to plan members beginning on or after August 1, 2012. In response to this directive within the ACA, the United States Department of Health and Human Services (HHS) charged the Institute of Medicine (IOM) with conducting a comprehensive review of women’s preventive health services and recommending those services deemed necessary for the health of women in the United States (Gee et al, 2011).

The Institute of Medicine Includes Breastfeeding in its Report on Preventive Services for Women

The Institute of Medicine Includes Breastfeeding in its Report on Preventive Services for Women

Women, Reproductive Health, and Health Reform

It is becoming more evident as trends and documented racial disparities emerge that the health needs of US woman are not being met. In response the Patient Protection and Affordable Care Act (ACA) promises continuous coverage for the approximately 19 million US women who currently lack health insurance and for the many more who have only sporadic coverage The promise of continuous health insurance coverage provides an opportunity to transform womens health with comprehensive care over their life course. The CDC supports this life-course perspective for reproductive life planning acknowledging that care for women cannot separate reproductive health from health promotion; pregnancy planning is an important component of preventive services for women. This article discusses three components of the ACA that are well suited to drive the transformation of womens health: patient-centered care system integration and value-driving service delivery. An integrated women’s health system will require improved use of the electronic medical record better workflow and communication across accountable care organizations and better-designed health information technology to meet the direct needs of patients. Reproductive life planning and accompanying family planning have the promise of decreasing the unplanned pregnancy rate optimizing womens health managing health pregnancies and improving birth outcomes - thereby affecting the health of the next generation.

Recognizing the Payoff for Investing in Prevention

Early in August, we had a major victory for prevention. The U.S. Department of Health and Human Services released requirements for new health insurance plans to cover eight preventive women’s health services at no cost for women (Institute of Medicine 2011). The recommended services are screenings for gestational diabetes, cervical cancer, HIV, and sexually transmitted infections; lactation counseling and breastfeeding support; screening and counseling for domestic violence; contraception; and yearly preventive care visits. These services were recommended by the Institute of Medicine Committee on Preventive Services for Women, who carefully considered the evidence upon which they based their recommendations. Major victories such as this one are the result of years of research from prevention scientists to understand modifiable risk factors; develop and test methods of screening and intervention; translate effective programs into practice; conduct effectiveness studies that also examine cost, dissemination, and adoption; and conduct methodological studies to strengthen the ways in which we research these topics. Manuscripts in this issue address important prevention topics such as drug use prevention in youth, the promotion of positive behaviors among young girls, an environmental intervention to increase access to fresh fruits and vegetables, the prevalence and emergence of cigar and cigarillo use among teens, suicide prevention, prevention of abuse, and ways Native American youth access health information. Studies in this issue reflect the prevention research continuum, from conducting needs assessments to more rigorous randomized designs. For example, the Rushing and Stephens article examines new technological avenues for reaching American Indian and Alaska Native youth, finding that as many as 75% of those youth reported searching online for health information. These data are already being used to design technology-based interventions for this high-risk population. At the other end of the research spectrum, Portwood and colleagues conducted a randomized trial to examine the impact of a primary prevention program, finding that the Adults and Children Together Against Violence Parents Raising Safe Kids program is a promising strategy to reduce child maltreatment in diverse communities. Another article by Cross and colleagues reminds us of the importance of training others to be agents of public health by examining approaches to better enhance and maintain suicide prevention gatekeeper skills over time. S. R. Tortolero (&) Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA e-mail: Susan.Tortolero@uth.tmc.edu

A structured women's preventive health clinic for residents: a quality improvement project designed to meet training needs and improve cervical cancer screening rates

Multiple resident-related factors contribute to 'missed opportunities' in providing comprehensive preventive care for female patients, including comfort level, knowledge and experience--all of which are compounded by resident turnover rates. Of particular concern among Internal Medicine (IM) residents is their knowledge and comfort level in performing pelvic exams. To evaluate the impact of a quality improvement project of implementing a Women's Preventive Health Clinic (WPHC) on addressing gaps identified by needs assessments: residents' comfort and knowledge with female preventive care and cervical cancer screening. The WPHC, a multidisciplinary weekly clinic, focused on preventive services for women with chronic conditions. The alternating didactic and clinic sessions emphasised women's preventive health topics for IM residents. Sixty-three IM residents participated in WPHC between 2002 and 2005. Pre- and post-test design was used to assess resident knowledge and comfort levels. Cervical cancer screening rates of residents' patients were assessed pre- and post-WPHC initiation. There was a significant improvement in general knowledge (64% correct at pretest vs 73% at post-test, p=0.0002), resident comfort level in discussing women's health topics and performing gynaecological exams (p<0.0002). Cervical cancer screening rates among IM residents' patients improved from 54% (pre-WPHC initiation) to 65% (post-WPHC initiation period). The results indicate that a focused resident preventive programme can meet gaps identified by education and needs assessments, and simultaneously have a positive impact on cervical cancer screening rates and thus may serve as a model for other residency programmes.

Caring for Somali women: Implications for clinician–patient communication

Objective We sought to identify characteristics associated with favorable treatment in receipt of preventive healthcare services, from the perspective of resettled African refugee women. Methods Individual, in-depth interviews with 34 Somali women in Rochester, NY, USA. Questions explored positive and negative experiences with primary health care services, beliefs about respectful versus disrespectful treatment, experiences of racism, prejudice or bias, and ideas about removing access barriers and improving health care services. Analysis was guided by grounded theory. Results Qualities associated with a favorable healthcare experience included effective verbal and nonverbal communication, feeling valued and understood, availability of female interpreters and clinicians and sensitivity to privacy for gynecologic concerns. Participants stated that adequate transportation, access to healthcare services and investment in community-based programs to improve health literacy about women's preventive health services were prerequisite to any respectful health care system. Conclusion Effective communication, access to healthcare services with female interpreters and clinicians, and community programs to promote health literacy are themes associated with respectful and effective healthcare experiences among Somali women. Practice implications Adequate interpreter services are essential. Patient-provider gender concordance is important to many Somali women, especially for gynecological concerns.

Physician Gender and Women's Preventive Services

ABSTRACT Objective: To determine whether the gender of women's regular physicians, controlling for physician specialty, is associated with women's receiving key preventive services within recommended intervals. Design: Cross-sectional, nationally representative women's health telephone survey conducted by Louis Harris and Associates in February and March 1993 for The Commonwealth Fund. Participants: A total of 2,525 women in the continental United States, ≥18 years old, including oversamples of African-American and Hispanic women. Main Outcome Measures: Receipt of each of five preventive services (blood pressure reading, Pap smear, cholesterol test, clinical breast examination, and mammogram) within specific periods. Results: Physician gender makes a significant difference for two specialty areas and for three preventive services. Patients of women family or general practitioners are more likely than the patients of men to have received a Pap smear or a blood cholesterol test within the last 3 years, and ...