Primary care provides an important opportunity for patients to access comprehensive reproductive health (RH) services, particularly as reductions to family planning programs continue.1 There is a lack of data on the specific RH services provided by primary care physicians (PCPs) and their perceptions of offering these services.2 Such information can aid in successfully expanding RH services in primary care. Our objectives were to determine the RH services New York State (NYS) PCPs report providing, their perception of the benefits and disadvantages to providing such services, and which RH services they felt were most important to offer.
We recruited a convenience sample of NYS PCPs through the American Medical Association (AMA) Master File, attendance at two NYS primary care conferences, and staff meetings at two NYS federally qualified health center (FQHC) networks. We describe the recruitment, data collection, and study instrument details, as well as report other findings elsewhere.3, 4 Our sample was more likely to be female, younger, and specialize in family medicine than the AMA sampling frame.
We conducted chi-squared and one-way ANOVA tests to assess significant differences by specialty in providing any RH or contraceptive services in the last year, and the mean number of perceived benefits and disadvantages (including barriers) to providing RH services, respectively.
Half of the physicians in our sample were female. The largest proportion of respondents was aged 42–59 (38%), followed by 36% aged 24–41. The majority of respondents provided at least one RH service in the last year (88%), with HIV/STI testing and counseling (74%) being the most common, followed by contraceptive counseling (67%) and cervical cancer screening (63%; Table 1). The least reported service provided was induced abortion (9%). The majority of respondents provided at least one contraceptive method/service (74%), most notably the pill (71%). Eighty-eight percent of family medicine physicians reported providing the pill, compared with 58% internal medicine providers. However, less than 40% of PCPs provided any of the other contraceptive services. A significantly larger proportion of family medicine physicians reported providing any RH (97% vs. 82%) and contraceptive service (91% vs. 61%) in the last year, compared with internal medicine respondents (p < 0.0001).
Respondents endorsed an average of 8.4 benefits, from a list of 14 (standard deviation (SD) 4.3, range 0–14; Table 2) associated with providing RH services in primary care settings, with increased access to RH services (82%) and patient convenience (82%) cited as the most common benefits. On average, respondents endorsed 1.5 disadvantages, from a list of 10 (SD 1.5, range 0–9). The most frequently held perceived disadvantage was not being sufficiently trained (51%), cited more often by internal medicine providers (66%) compared with family medicine respondents (38%). This was followed by additional time that may detract from other primary care services (32%); over a third reported no disadvantages (36%). Family medicine physicians had significantly higher average perceived benefits (9.8 vs. 6.7, 9.5) and fewer disadvantages (1.1 vs. 2.0, 1.8), compared with internal medicine and other PCPs (p < 0.0001). However, the majority of internal medicine providers noted many benefits.
Respondents felt the most important RH services to add to their clinic were contraceptive counseling (29%) and cervical cancer screening (29%), followed by HIV/STI testing and counseling (27%), all endorsed by more internal medicine respondents.
Although PCPs in our sample offer some RH services, there is room for expansion of comprehensive services. Our findings may reflect differences in RH training by specialty. As compared with internal medicine physician respondents, family medicine physician respondents are already providing more RH services and may be more comfortable with the prospect of further expanding such services, given recommendations from the American Academy of Family Physicians to integrate such services.5 Recognizing the differences in experiences, perspectives, and current scope of practice by PCP training is important when considering changes in practice protocols. Training on RH service delivery, particularly for internal medicine physicians, may be needed prior to implementation. As this is a convenience sample, our findings cannot be generalized to PCPs in NYS or elsewhere. Some respondents recruited at conferences may have been sub-specialists. Nonetheless, given the receptivity to providing RH care across sub-specialties, this study can inform administrators, clinicians, and educators considering expansion of RH services in primary care.
Zolna M, Finn S, Frost J. Estimating the impact of changes in the Title X network on patient capacity. Guttmacher Institute. February 5, 2020. https://www.guttmacher.org/article/2020/02/estimating-impact-changes-title-x-network-patient-capacity. Accessed May 11, 2020.
Bello JK, Rao G, Stulberg DB. Trends in contraceptive and preconception care in United States ambulatory practices. Fam Med. 2015;47(4):264-271.
Manze M, Calixte C, Romero D, et al. Physician perspectives on routine pregnancy intention screening and counseling in primary care. Contraception. 2020;101(2):91-96.
Jones H, Calixte C, Manze M, et al. Primary care patients’ preferences for reproductive health service needs assessment and service availability in New York Federally Qualified Health Centers. Contraception. 2020;101(4):226-230.
American Academy of Family Physicians. Summary of recommendations for clinical preventive services. July 2017; Order No. 1968.
This research was funded by the Society for Family Planning Research Fund (#SFPRF10-II2-5). The funding source was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The views and opinions expressed are those of the authors and do not necessarily represent the views and opinions of SFPRF.
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The authors declare that they do not have no a conflict of interest.
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Manze, M.G., Jones, H.E., Roberts, L. et al. New York State Primary Care Physician Practices and Perspectives on Offering Reproductive Health Services. J GEN INTERN MED 36, 1805–1807 (2021). https://doi.org/10.1007/s11606-020-06162-w