title: Use of private gynaecologist does not relate to better prevention outcomes - an ecological analysis from Finland.
abstract: BACKGROUND
  Control of reproduction and prevention of reproductive health problems are important reasons for women to use health services, but the proper organisational level of service provision is not clear. The purpose of this study was to investigate whether visits to private gynaecologists correlate with better health outcomes and worse participation in organised screening for cancer programs.
  
  
  METHODS
  This is an ecological analysis using municipalities and groups of women at 5-year age intervals within municipalities as study units. First, the Finnish municipalities (n = 452) were classified into three groups by the age-adjusted level of use of private gynaecologists. Secondly, each age group within municipalities was classified into tertiles by the level of private gynaecologist use. The outcomes were participation in cervical and organised breast cancer screening for cancer programmes, stage of gynaecological and breast cancers at diagnosis, and abortion rates and ratios. All data were obtained from national registers by groups at 5-year age intervals and by municipality. Raw and adjusted (age groups, and in some analyses, municipality social class index) odds ratios, total and by urbanity, were calculated.
  
  
  RESULTS
  The proportions of women participating in cervical cancer and organised breast cancer screening for cancer were somewhat higher in the groups having a low use of private gynaecologists. The proportions of local cancers of all cervical, uterine, ovarian and breast cancers were similar in the three groups, even though the first analysis method suggested somewhat better results for the low-use group in case of cervical cancer and for the high-use group in case of uterine and breast cancer. The rates of induced abortion were higher in municipalities having a high use of private gynaecologists than in those having lower use.
  
  
  CONCLUSIONS
  This ecological analysis suggests that frequent use of private gynaecologists relates somewhat to lower organised screening for cancer participation, and is not better in preventing abortions or in detecting cancer earlier. Our results suggest that a planned system relying mainly on general practitioners and public health nurses as the first line care providers is equally good for women's reproductive health as that in which specialists are used.
authors.affiliation: National Research and Development Centre for Welfare and Health (STAKES), P,O, Box 220, 00531 Helsinki, Finland. elina.hemminki@stakes.fi
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
authors.forename: Tiina
authors.initials: T
authors.lastname: Sevon
authors.forename: Kati
authors.initials: K
authors.lastname: Tanninen
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
mesh_terms: D000328:Adult; D000367:Age Factors; D005194:Family Practice; D005260:Female; D005387:Finland; D006176:Gynecology / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D011637:Public Health Nursing; D034121:Reproductive Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014932:Women's Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*