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Obstetrical & Gynecological Survey:
CME Program: Category 1 CME Review Articles 22, 23, and 24

Practice Trends in Outpatient Obstetrics and Gynecology: Findings of the Collaborative Ambulatory Research Network, 1995–2000

Hill, Lauren D. MA*; Erickson, Kristine PhD*; Holzman, Gerald B. MD†; Power, Michael L. PhD* and; Schulkin, Jay PhD‡

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Abstract

Historically, obstetrics and gynecology has been a medical/surgical specialty focusing on women’s health and reproductive concerns during the childbearing years. Newer responsibilities—for example, in primary care, gerontology, and genetics—require Ob-Gyns to draw upon a base of medical knowledge that traditionally was not considered germane to their practices. Ob-Gyns are increasingly providing more primary care services to their patients; consequently, the field has expanded considerably. The Collaborative Ambulatory Research Network (CARN) was created in 1990 as a vehicle for investigating issues pertinent to women’s health and to the practice of obstetrics and gynecology in the outpatient setting. This article summarizes the findings of CARN studies from 1995 to 2000, covering a range of topics related to women’s health across the life cycle, including, but not limited to perinatal care. Topics include nutrition, infectious disease, hormone replacement therapy, psychosocial issues, and genetic testing in obstetric and gynecologic practice. Each study produced a picture of current practice patterns and knowledge of the physicians surveyed. Findings on knowledge, attitudes, and practices varied widely. Overall, Ob-Gyns were knowledgeable and consistent in more traditional areas of practice. Conversely, inconsistencies were observed in newer areas.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader will be able to define what the Collaborative Ambulatory Research Network (CARN) involves, describe how CARN obtains its data, and summarize some of the findings of CARN from the years 1995 to 2000.

Traditionally, obstetricians and gynecologists (Ob-Gyns) have provided specialized care for women, focusing on gynecologic, reproductive, or perinatal health. Similar to physicians in other specialties, Ob-Gyns are increasingly providing more primary care services to their patients (1). As such, Ob-Gyns are called upon to have both breadth and depth of knowledge about a range of women’s health issues. Additionally, contemporary obstetric-gynecologic practice has begun to incorporate aspects of preventive health care and evidence-based medicine. The Collaborative Ambulatory Research Network (CARN) project provides timely information on practice patterns in rapidly expanding areas of clinical care and helps to identify physicians’ changing educational needs. This, in turn, influences the development of educational materials for physicians and patients and suggests strategies for disseminating prevailing knowledge.

The Collaborative Ambulatory Research Network project began in 1990, funded by a grant to the American College of Obstetricians and Gynecologists (ACOG) from the Maternal and Child Health Bureau. Part of the original impetus for the CARN was the observation that a substantial portion of information about medical care was derived from hospital-based research. The CARN project was designed as a way to discern the practice trends and knowledge base of Ob-Gyns practicing in the ambulatory care setting. This descriptive, normative information has proven to be very valuable, and is used to inform and direct a variety of ACOG-sponsored efforts. Other medical specialties, such as pediatrics, have also begun to study changes, strengths and challenges in medical care through practice-based research networks (2). Findings from CARN studies conducted from 1990 to 1994 are described elsewhere (3). The current article summarizes CARN studies from 1995 to 2000.

© 2001 Lippincott Williams & Wilkins, Inc.

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