Assessing Primary Care Performance in an Obstetrics/Gynecology Clinic

OBJECTIVES: Young, low-income women often use ob/gyns for routine care. Yet, little is known about the extent to which these settings achieve primary care goals. This study compared primary care performance among young low-income women using ob/gyns versus other settings as their primary care providers (PCP). METHODS: Anonymous interviews with 158 women on Medical Assistance age 18-44 seen at a university ob/gyn clinic. RESULTS: Sixty women (38.0%) used the ob/gyn setting for primary care, 83 (52.5%) use other places and 15 (9.5%) identified no primary care provider. Compared to women using other places for primary care, women who used the ob/gyn setting as their PCP were younger (OR 0.93, p = .04), had less education (OR 3.9, p = .02), and more frequently had small children (OR 2.8, p = .05) and reported illicit drug use (OR 3.1, p = .05). Performance on first contact care, ongoing care, coordination, and family and community issues did not vary by whether the PCP was an ob/gyn versus another provider, though women with an ob/gyn PCP rated their provider significantly higher on cultural competence. Access to advice on general medical prevention topics differed little by type of PCP; however, women who used the ob/gyn clinic as PCP received advice on more reproductive health, behavioral health, and injury prevention topics, with a mean number of preventive topics of 13.0 (SD 3.6) versus 6.3 (SD 4.1) (p < .01). DISCUSSION: Many young women who rely on hospital-based ob/gyn clinics for primary care may benefit from expanded health promotion efforts. The large portion of young, low-income women using ob/gyn settings for primary care may receive primary care of equal or better quality compared to women using other settings. More research is needed to see if these findings are generalizable.