A population-based study of US women's preferred versus usual sources of reproductive health care.
OBJECTIVE
We characterized US women's preferred and usual sources of reproductive health care.


METHODS
Data were drawn from the Women's Health Care Experiences and Preferences Study, an Internet survey of 1078 women aged 18-55 years randomly sampled from a national probability panel. We described and compared women's preferred and usual sources of care (women's health specialists including obstetricians-gynecologists and family-planning clinics, primary care, other) for Papanicolaou/pelvic examination, contraception, and sexually transmitted infection (STI) services using χ(2), logistic regression, and kappa statistics.


RESULTS
Among women reporting health service utilization (n = 984, 92% overall; 77% Papanicolaou/pelvic; 33% contraception; 8% STI), women's health specialists were the most used sources of care for Papanicolaou/pelvic (68%), contraception (74%), and STI (75%) services. Women's health specialists were also the most preferred care sources for Papanicolaou/pelvic (68%), contraception (49%), and STI (35%) services, whereas the remainder of women preferred primary care/other sources or not to get care. Differences in preferred and usual care sources were noted across sociodemographic groups, including insurance status and income level (P < .05). Preference for women's health specialists was the strongest predictor of women's health specialist utilization for Papanicolaou/pelvic (adjusted odds ratio, 48.8; 95% confidence interval, 25.9-91.8; P < .001) and contraceptive (adjusted odds ratio, 194.5; 95% confidence interval, 42.3-894.6; P < .001) services. Agreement between preferred and usual-care sources was high for Papanicolaou/pelvic (85%, kappa, 0.63) and contraception (86%; kappa, 0.64) services; disagreement (range, 15-22%) was associated with insurance, employment, income, race, and religion (P < .05).


CONCLUSIONS
Women's preferences for and use of women's health specialists for reproductive health care has implications for efforts to define the role of obstetricians-gynecologists and family planning clinics in current health systems.
Department of Obstetrics and Gynecology, Institute for Social Research, University of Michigan, Ann Arbor, MI. Electronic address: hkelli@umich.edu.
Kelli Stidham
KS
Hall
Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI.
Elizabeth W
EW
Patton
School of Medicine, University of Michigan, Ann Arbor, MI.
Halley P
HP
Crissman
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
Melissa K
MK
Zochowski
Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Vanessa K
VK
Dalton
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003267:Contraception / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data*; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D057240:Patient Preference; D011320:Primary Health Care / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000628:therapy; D012923:Social Class; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000706:statistics & numerical data*; D055815:Young Adult
health service preferences; reproductive health care; women’s health service utilization