Fitzhugh Mullan Institute for Health Workforce Equity, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
JAMA Health Forum. 2023 Mar 3;4(3):e230106. doi: 10.1001/jamahealthforum.2023.0106.
Little is known about primary care physicians who provide contraceptive services to Medicaid beneficiaries. Evaluating this workforce may help explain barriers to accessing these services since contraceptive care access is critical for Medicaid beneficiaries' health.
To describe the primary care physician workforce that provides contraceptive services to Medicaid beneficiaries and explore the factors associated with their Medicaid contraceptive service provision.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted from August 1 to October 10, 2022, used data from the Transformed Medicaid Statistical Information System from 2016 for primary care physicians from 4 specialties (family medicine, internal medicine, obstetrics and gynecology [OBGYN], and pediatrics).
The main outcomes were providing intrauterine devices (IUDs) or contraceptive implants to at least 1 Medicaid beneficiary, prescribing hormonal birth control methods (including a pill, patch, or ring) to at least 1 Medicaid beneficiary, the total number of Medicaid beneficiaries provided IUDs or implants, and the total number Medicaid beneficiaries prescribed hormonal birth control methods in 2016. Physician- and community-level factors associated with contraceptive care provision were assessed using multivariate regression methods.
In the sample of 251 017 physicians (54% male; mean [SD] age, 49.17 [12.58] years), 28% were international medical graduates (IMGs) and 70% practiced in a state that had expanded Medicaid in 2016. Of the total physicians, 48% prescribed hormonal birth control methods while 10% provided IUDs or implants. For OBGYN physicians, compared with physicians younger than 35 years, being aged 35 to 44 years (odds ratio [OR], 3.51; 95% CI, 2.93-4.21), 45 to 54 years (OR, 3.01; 95% CI, 2.43-3.72), or 55 to 64 years (OR, 2.27; 95% CI, 1.82-2.83) was associated with higher odds of providing IUDs and implants. However, among family medicine physicians, age groups associated with lower odds of providing IUDs or implants were 45 to 54 years (OR, 0.66; 95% CI, 0.55-0.80), 55 to 64 years (OR, 0.51; 95% CI, 0.39-0.65), and 65 years or older (OR, 0.29; 95% CI, 0.19-0.44). Except for those specializing in OBGYN, being an IMG was associated with lower odds of providing hormonal contraceptive service (family medicine IMGs: OR, 0.80 [95% CI, 0.73-0.88]; internal medicine IMGs: OR, 0.85 [95% CI, 0.77-0.93]; and pediatric IMGs: OR, 0.85 [95% CI, 0.78-0.93]). Practicing in a state that expanded Medicaid by 2016 was associated with higher odds of prescribing hormonal contraception for family medicine (OR 1.50; 95% CI, 1.06-2.12) and internal medicine (OR, 1.71; 95% CI, 1.18-2.48) physicians but not for physicians from other specialties.
In this cross-sectional study of primary care physicians, physician- and community-level factors, such as specialty, age, and the Medicaid expansion status of their state, were significantly associated with how they provided contraceptive services to Medicaid beneficiaries. However, the existence of associations varied across clinical specialties. Ensuring access to contraception among Medicaid beneficiaries may therefore require policy and program approaches tailored for different physician types.
重要性：为医疗补助受益人提供避孕服务的初级保健医生鲜为人知。评估这一劳动力队伍可能有助于解释获得这些服务的障碍，因为获得避孕服务对医疗补助受益人的健康至关重要。
目的：描述为医疗补助受益人提供避孕服务的初级保健医生队伍，并探讨与他们提供医疗补助避孕服务相关的因素。
设计、地点和参与者：这是一项横断面研究，于 2022 年 8 月 1 日至 10 月 10 日进行，使用了来自四个专业（家庭医学、内科、妇产科和儿科学）的初级保健医生的 2016 年转化后的医疗补助统计信息系统的数据。
主要结果和措施：主要结果是至少为 1 名医疗补助受益人提供宫内节育器（IUD）或避孕植入物，至少为 1 名医疗补助受益人开处方激素避孕方法（包括药丸、贴片或环），2016 年提供 IUD 或植入物的医疗补助受益人的总数，以及开处方激素避孕方法的医疗补助受益人的总数。使用多变量回归方法评估了与避孕护理提供相关的医生和社区层面的因素。
结果：在 251017 名医生的样本中（54%为男性；平均[SD]年龄为 49.17[12.58]岁），28%是国际医学毕业生（IMG），70%在 2016 年扩大医疗补助的州行医。在所有医生中，48%开处方激素避孕方法，10%提供 IUD 或植入物。与年龄小于 35 岁的医生相比，妇产科医生中，年龄在 35 至 44 岁（优势比[OR]，3.51；95%置信区间[CI]，2.93-4.21）、45 至 54 岁（OR，3.01；95%CI，2.43-3.72）或 55 至 64 岁（OR，2.27；95%CI，1.82-2.83）与提供 IUD 和植入物的可能性更高相关。然而，在家庭医学医生中，与提供 IUD 或植入物的可能性较低相关的年龄组为 45 至 54 岁（OR，0.66；95%CI，0.55-0.80）、55 至 64 岁（OR，0.51；95%CI，0.39-0.65）和 65 岁及以上（OR，0.29；95%CI，0.19-0.44）。除了专门从事妇产科的医生外，作为国际医学毕业生与提供激素避孕服务的可能性较低相关（家庭医学 IMG：OR，0.80[95%CI，0.73-0.88]；内科医学 IMG：OR，0.85[95%CI，0.77-0.93]；儿科 IMG：OR，0.85[95%CI，0.78-0.93]）。到 2016 年，所在州扩大医疗补助的情况与家庭医学（OR 1.50；95%CI，1.06-2.12）和内科（OR，1.71；95%CI，1.18-2.48）医生开处方激素避孕药的可能性更高相关，但与其他专业的医生无关。
结论和相关性：在这项对初级保健医生的横断面研究中，医生和社区层面的因素，如专业、年龄以及他们所在州的医疗补助扩大情况，与他们为医疗补助受益人提供避孕服务的方式显著相关。然而，关联的存在因临床专业而异。因此，确保医疗补助受益人的避孕服务可能需要针对不同类型医生的政策和方案方法。
