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Narumoto K, Miyazaki K, Inoue M, Kaneko M, Okada T, Sugimura M. Investigating women’s health issues and help-seeking intentions in primary care in Japan: a cross-sectional study. BMC PRIMARY CARE 2022; 23:250. [PMID: 36163008 PMCID: PMC9511763 DOI: 10.1186/s12875-022-01862-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/14/2022] [Indexed: 11/13/2022]
Abstract
Background Many women face a variety of barriers to seeing obstetricians and gynecologists (OB/GYNs). Primary care physicians (PCPs) in Japan are not well equipped to address and adequately handle women’s health issues. Hence, opportunities for women to consult PCPs about women’s health issues are often limited during busy outpatient encounters. It is essential to explore PCP’s roles in women’s health care by examining women’s health needs in a primary care setting. The aim of the study is to describe the prevalence and distribution of women’s health issues and help-seeking intentions among women visiting a primary care clinic. Methods This was a cross-sectional study using a questionnaire. We included women aged 20–60 years who visited a primary care clinic for any reason. The questionnaire comprised a list of women’s health issues, the General Help Seeking Questionnaire to assess help-seeking intentions, and participants’ demographics including their reasons for visiting and regularity of OB/GYN visits. Results We distributed the questionnaire to 294 women and analyzed 260 valid responses. The average age of the respondents was 40.5 years old, and they had an average of 5.2 clinic visits a year. Approximately half of them (50.4%) visited for their own care. One hundred thirty-nine (53.9%) reported at least one women’s health issue, and 73.9% of them had no regular visit to an OB/GYN. The major concerns of women’s health issues included gynecological cancer screenings and menstrual problems. The distribution of help-seeking intentions for each source of care appeared to be classified into three patterns. One fifth of the women indicated high help-seeking intentions for PCPs, and a greater number of women expressed higher help-seeking intentions for PCPs when they did not regularly see an OB/GYN. Conclusions A significant number of women who visited a primary care clinic had a specific concern about women’s health issues, and a majority of them had not regularly visited their OB/GYN. PCPs may have an important role in providing an opportunity for women to discuss their concerns about women’s health issues as part of comprehensive care during a daily clinical encounter.
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Sorpreso ICE, Figueiredo FWDS, Silva ATMD, Zangirolami-Raimundo J, Silva BKR, Adami F, Zuchelo LTS, Baracat EC, Soares Júnior JM, Abreu LCD. Diagnosis and referral flow in the single health system for climacteric women. Rev Assoc Med Bras (1992) 2020; 66:1036-1042. [PMID: 32935795 DOI: 10.1590/1806-9282.66.8.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women. METHODS This is a cross-sectional study conducted at the Women's Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio. RESULTS Smoking (OR = 2.27, 95% CI 1.05-4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs. CONCLUSION Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.
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Affiliation(s)
- Isabel Cristina Esposito Sorpreso
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil.,. Laboratório de Delineamentos de Estudos e Escrita Científica, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | - Francisco Winter Dos Santos Figueiredo
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil.,. Laboratório de Epidemiologia e Análise de Dados, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | | | - Juliana Zangirolami-Raimundo
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil.,. Laboratório de Delineamentos de Estudos e Escrita Científica, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | | | - Fernando Adami
- . Laboratório de Epidemiologia e Análise de Dados, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil
| | - Lea Tami Suzuki Zuchelo
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Edmund Chada Baracat
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Maria Soares Júnior
- . Disciplina de Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luiz Carlos de Abreu
- . Laboratório de Delineamentos de Estudos e Escrita Científica, Centro Universitário Saúde ABC (FMABC), Santo André, SP, Brasil.,. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (Emescam), Vitória, ES Brasil
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Fetters MD, Guetterman TC. Discovering and doing family medicine and community health research. Fam Med Community Health 2019; 7:e000084. [PMID: 32148707 PMCID: PMC6910740 DOI: 10.1136/fmch-2018-000084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/17/2018] [Accepted: 01/24/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy C Guetterman
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Visits to Pediatric Clinics by Adult Patients: A Nationwide Survey in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071538. [PMID: 30036974 PMCID: PMC6069158 DOI: 10.3390/ijerph15071538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 12/03/2022]
Abstract
Pediatricians are trained to provide non-surgical medical care to children. Improvements in medical treatments and surgical techniques have extended the survival of children with congenital diseases and chronic illnesses. Consequently, pediatricians may provide continuous medical service to their patients into adulthood. Meanwhile, as Taiwan’s birth rate has fallen to one of the lowest in the world, pediatricians are encountering growing competition. As a source of continued revenue, pediatricians could also provide medical care to adults with common diseases and patients with adult-onset chronic diseases. The aim of this study was to investigate the pattern of adult ambulatory visits to pediatric clinics recorded by Taiwan’s National Health Insurance (NHI) system during 2000 to 2011. From 1/500 sampling datasets, we found that adult ambulatory visits to pediatric clinics rose steadily and statistically significantly from 16% of total visits to pediatric clinics in 2000 to 32% in 2011. Analysis of the diagnoses associated with adult ambulatory visits to pediatric clinics indicated that the most common diagnoses for such patients at academic medical centers were chronic illnesses, including epilepsy, cardiac and circulatory congenital anomalies, and diabetes. Meanwhile, at physician clinics, airway infections/diseases and gastroenteritis were the most common diagnoses. In an era of low birth rates, our findings contribute to an evidence-based discussion and provide new information that may assist in healthcare policymaking.
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da Silva ATM, Menezes CL, de Sousa Santos EF, Margarido PFR, Soares JM, Baracat EC, de Abreu LC, Sorpreso ICE. Referral gynecological ambulatory clinic: principal diagnosis and distribution in health services. BMC WOMENS HEALTH 2018; 18:8. [PMID: 29304796 PMCID: PMC5756344 DOI: 10.1186/s12905-017-0498-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 12/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of women's health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. METHOD This is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Women's Health, the facility in gynecology and training for Family and Community Medical Residents, São Paulo, Brazil, from 2012 to 2014. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. RESULTS The female patients present non-inflammatory disorders of the female genital tract (81.07%, n = 347) and diseases of the urinary system (22.66%, n = 97) among the gynecological diagnoses. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.00-16.29) and 2.56 times (CI 1.58-4.16) higher, respectively, than during the non-reproductive period. The non-inflammatory disorders of the female genital tract (93.33%, n = 28) are most related to the tertiary sector. The distribution in health services was the following: 71.30% (n = 305) in the primary sector, 21.70% (n = 93) in the secondary sector and 7% (n = 30) in the tertiary sector. CONCLUSION The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Low-assistance complexity followed in most cases.
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Affiliation(s)
- Adna Thaysa Marcial da Silva
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil. .,Laboratory of Study Design and Scientific Writing, ABC Medical School, São Paulo, SP, Brazil. .,, Avenida Enéas de Carvalho Aguiar, 255 - 10° andar sala 10166, São Paulo, SP, CEP: 05403000, Brazil.
| | | | | | | | - José Maria Soares
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Laboratory of Study Design and Scientific Writing, ABC Medical School, São Paulo, SP, Brazil
| | - Isabel Cristina Esposito Sorpreso
- Division of Gynecology, Medical School, University of São Paulo, São Paulo, SP, Brazil.,Laboratory of Study Design and Scientific Writing, ABC Medical School, São Paulo, SP, Brazil
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Abstract
This study aimed to describe the ecology of medical care in Korea. Using the yearly data of 2012 derived from the Korea Health Panel, we estimated the numbers of people per 1,000 residents aged 18 and over who had any health problem and/or any medical care at a variety of care settings, such as clinics, hospitals, and tertiary hospitals, in an average month. There was a total of 11,518 persons in the study population. While the number of those who had any health problem in an average month was estimated to be 939 per 1,000 persons, the estimated numbers of ambulatory care users were 333 at clinics, 101 at hospital outpatient departments, 35 at tertiary hospital outpatient departments, and 38 for Korean Oriental medical providers. The number of people who used emergency care at least once was 7 per 1,000 persons in an average month. The numbers of people hospitalized in clinics and hospitals were 3 and 8, respectively, while 3 persons were admitted to tertiary hospitals. There was a gap between the number of people experiencing any health problem and that of those having any medical care, and primary care comprised a large share of people's medical care experiences. It was noteworthy that more patients received ambulatory care at tertiary hospitals in Korea than in other countries. We hope that discussion about care delivery system reform and further studies will be encouraged.
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Affiliation(s)
- Yong Soo Kim
- Public Health Policy Institute, Seoul Metropolitan Government, Seoul, Korea
| | - Yong Jun Choi
- Department of Social and Preventive Medicine, College of Medicine, Hallym University, Chuncheon, Korea
- Health Services Research Center, Hallym University, Chuncheon, Korea.
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Cohen AJ, Packiam VT, Nottingham CU, Alberts BD, Faris SF, Bales GT. 30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective Database. Urology 2016; 95:72-9. [DOI: 10.1016/j.urology.2016.04.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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Lynn AM, Lai LJ, Lin MH, Chen TJ, Hwang SJ, Wang PH. Pattern of Ambulatory Care Visits to Obstetrician-Gynecologists in Taiwan: A Nationwide Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6832-41. [PMID: 26086705 PMCID: PMC4483733 DOI: 10.3390/ijerph120606832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022]
Abstract
Although obstetrician-gynecologists (OB-GYNs) are the main actors in the provision of health care to women, their practice patterns have rarely been analyzed. The current study investigated the nationwide ambulatory visits to OB-GYNs in Taiwan using the National Health Insurance Research Database. From the 1/500 sampling datasets indicating 619,760 ambulatory visits in 2012, it was found that 5.8% (n = 35,697) of the visits were made to OB-GYNs. Two-fifths of the services provided were performed by male OB-GYNs aged 50-59 years. Women of childbearing age accounted for more than half of the visits to OB-GYNs (57.2%), and elderly patients above 60 years accounted for only 7.7%. The most frequent diagnoses were menstrual disorders and other forms of abnormal bleeding from the female genital tract (13.1%). Anti-infective agents were prescribed in 15.1% of the visits to OB-GYNs. The study revealed the proportion of aging practicing OB-GYNs, and our detailed results could contribute to evidence-based discussions on health policymaking.
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Affiliation(s)
- An-Min Lynn
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Li-Jung Lai
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Peng-Hui Wang
- School of Medicine, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei 112, Taiwan.
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
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