Services provided to nonpregnant women during general medical and gynecologic examinations in the United States

Objectives: To estimate the number of visits coded as general medical or gynecologic examinations (GMGEs) per 100 nonpregnant women aged ≥18 years per year, to examine the content of the services provided during those examinations, to examine the degree of agreement between the patient’s stated reason for visits and the diagnosis coded by physicians for GMGEs, and to examine the extent of preventive services delivered during GMGE visits and non-GMGE visits. Methods: We analyzed data from two national surveys: the 1997 National Ambulatory Medical Care Survey and 1997 National Hospital Ambulatory Medical Care Survey. In addition, we obtained the number of women aged ≥18 years in the United States from the Bureau of Census and the number of women who were pregnant from the National Center for Health Statistics. Results: The number of visits coded as GMGEs by physicians was estimated to be <21 visits per 100 nonpregnant women aged ≥18 years per year. The leading four services provided during a GMGE were blood pressure check, breast examination, pelvic examination, and Papanicolaou (Pap) test. Of the visits coded as GMGEs by physicians, 82% of patients stated that their reason for visit was a GMGE. Only 35% of the visits that were initially considered to be GMGEs by patients were classified as such by physicians. For the visits initially considered to be GMGEs by patients, women were more likely to receive preventive services if the visits were also classified as GMGEs by physicians. Of Pap tests provided to nonpregnant women aged ≥18 years, 44% were provided during these visits that were classified as non-GMGE visits by both physicians and by patients. Conclusions: GMGEs were important means of delivering preventive services to nonpregnant women, but not many women had GMGE visits. Evaluation of the acceptability and cost effectiveness of GMGEs to deliver preventive services to different populations is needed.