June 6, 2012

Minority, Young Women Avoid Yearly Checkups

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Many Connecticut women aren’t getting annual preventive health care, and the problem is worse among minorities and young adults, according to a new survey.

The survey found that 28 percent of women had not had an ob-gyn exam in the past year.  Among minority women, 38 percent had not had an ob-gyn exam in the past year; and for young women 18 to 29, the number was 36 percent. One in 10 minority women reported they had not seen a gynecologist or a primary care doctor in the past year. That is double the rate reported by white women. Young and minority women were also less likely to get pap smears on schedule.

The findings come from a survey of 1,000 women between the ages of 18 and 54 commissioned by Women’s Health Connecticut, a company that provides management services for physician practices.

The survey did not identify the causes of these disparities, said Dr. Mark DeFrancesco, chief medical officer for Women’s Health Connecticut and a gynecologist practicing in Waterbury.  Racial health disparities are well documented nationally, he said, but “maybe there are subtle things that happen (that contribute to the problem) and we can educate our doctors.”

DeFrancesco found it easier to explain young women’s neglect of an annual exam. “Younger people are going to feel more immortal and don’t care about health care as much,” he said.

Young women reported problems talking with their gynecologists. They are less likely than older women to strongly agree that their typical interactions with their ob-gyn are comfortable (57 percent vs. 73 percent). Sixty percent of young women said that they trusted their gynecologist, for older women it was 75 percent.

Less than half of all women said they were “very satisfied” with the information they got from their doctors about common health issues. They reported being even less satisfied with the information they got on sensitive issues, such as infertility and pain during intercourse, and also said they were less comfortable discussing those topics.

“Doctors don’t have the time they used to have to spend with patients,” said DeFrancesco. During limited office visits, physicians must “learn to be more receptive,” he said. Working with nurse practitioners and midwives can offer patients more contact, he added.

The survey also found that only 52 percent of women knew the age at which they should start getting mammograms or how often they should get pap smears. Women’s Health Connecticut CEO Nancy Bernstein pointed out that guidelines for both tests changed in 2009, perhaps creating confusion for women.

In 2009, U.S. Preventive Services Task Force, an expert panel that reviewed the literature on breast cancer screenings, recommended that most women begin mammograms at age 50. The National Cancer Institute and American Cancer Society, however, continue to recommend that the screenings begin at age 40. Also in 2009, the American College of Obstetricians and Gynecologists recommended that women have pap tests every other year beginning at age 21. Frequency can decrease with age and a series of negative tests, according to the college.

The complexity of the guidelines reinforces the need for providers to be up-to-date and to talk with their patients about health screenings, said DeFrancesco. Furthermore, they need to let women know that an exam is “not just a pap smear” but an opportunity to address issues ranging from domestic violence to weight and smoking. “We need to redesign the annual visit,” he said.

The survey underlines the need to make every doctor’s office “a judgment-free zone,” said Bernstein, and should encourage doctors to proactively ask about subjects women may be uncomfortable raising themselves. “We need to make sure they are satisfied so that they will come back,” she said.

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