Are older physicians current on screening?

Younger physicians are more apt to test

A study by Prudential HealthCare of prenatal care screening tests indicates that OB/GYNs who graduated from medical school before the mid-1960s were less likely to perform certain screening tests.

The study, which was performed by the Prudential Center for Health Care Research in Atlanta, looked at physician characteristics in following national prenatal care guidelines.1,2 Recommended tests include blood typing, Rh antibody testing, hemoglobin and hematocrit, and syphilis serology. (See tables, p. 23.)

Julie A. Gazmararian, MPH, PhD, senior health care analyst for the Prudential Center for Health Care Research, says data for the study were obtained from the 1992 Prudential Health Employer Data and Information Set (HEDIS) and from the Prudential National Medical Provider Survey (NMPS). HEDIS was developed by the National Committee on Quality Assurance in Washington, DC, as a way to measure quality indicators in managed care organizations.

Those data included 2,184 patients age 10 to 49 who had been continually enrolled in a Prudential managed care plan for a year before having a live birth in 1992. She says data on 905 OB/GYNs such as their sex, age, and year of medical school graduation were obtained from the NMPS, a database maintained by Prudential.

Results of the study indicated that pregnant women received most of the recommended prenatal screening tests such as blood pressure, hepatitis B surface antigen screening, and blood typing more than 90% of the time. Results were consistent, even after controlling for factors such as the health plan’s region. However, four tests were ordered less than 90% of the time, as follows:

• glucose challenge (87.5%);

• alpha-fetaprotein (72.1%);

• repeat hemoglobin/hematocrit (71%);

• and urinalysis (68.3%),

Women who saw an OB/GYN who graduated from medical school within the last 30 years were more likely to receive those tests from 73% to 98% of the time. (See graph, above.)

Gazmararian says the prenatal screening test rates in the study still were higher than rates found in other similar studies, which are reported as low as 54% for urinalysis screening.3

How does she explain the results? Gazmararian says that older age itself may not be a contributing factor to the study’s results.

"When you looked at the specific tests where there were differences by when physicians graduated, most of the tests had been recommended for at least 30 years," she notes. "So that doesn’t support the hypothesis that physicians who have been out of school longer don’t order the tests because the recommendations have changed."

Is documentation the problem?

She says it is possible that older physicians simply didn’t document screening tests as well as younger ones. "The tests may be occurring, but they’re just not being documented in the medical record," Gazmararian says.

Some older physicians may not order some tests because they may not be as accepting of them, though. For example, repeat hemoglobin and hematocrit tests were only ordered by 54% of older physicians in the study. "If there are no problems on the initial [hemoglobin and hematocrit], then it may not be repeated," she notes.

Prudential will be presenting the data to its medical committee and administrators, who may decide to step up educational efforts to older physicians through seminars and written materials on appropriate prenatal screening tests, she adds.

"I think the results suggest that we should be targeting educational opportunities to physicians who have been out of school for 30 years or longer in terms of recommended prenatal screening tests," Gazmararian says.

References

1. The American College of Obstetricians and Gynecologists. Standards for obstetric-gynecologic services. Sixth Edition. Washington, DC: American College of Obstetricians and Gynecologists, 1985.

2. U.S. Public Health Service Panel on the Content on Prenatal Care. Caring for our future: The content of prenatal care. Washington, DC: U.S. Public Health Service, U.S. Department of Health and Human Services; 1989.

3. Baldwin LM, Raine T, Jenkins LD, et al. Do providers adhere to ACOG standards? The case of prenatal care. Obstet Gynecol 1994; 84:549-556.