The role of the obstetrician/gynecologist in the prevention of cardiovascular disease in women

Purpose: A qualitative study was conducted to understand the current and potential role of the community obstetrician/gynecologist (OBGYN) in risk factor screening and prevention of cardiovascular disease. Methods: A total of four focus group discussions were conducted among 46 OBGYN residents and practicing physicians in the mid-Atlantic region. Main Findings: Five main thematic areas were identified including scope of practice, professional knowledge and skills in non-reproductive care, potential for liability, logistical and structural barriers, medical practice community, and support for collaborative care. There were no differences between residents and those in practice within and between cities. Comprehensive care was most often defined as excluding chronic medical care issues and most likely as focusing on screening and referring women. The OBGYN recognized their common role as the exclusive clinician for women was, in part, a consequence of patients' nonadherence with primary care referrals. Barriers and strategies were identified within each thematic area. Conclusion: Additional training, development of referral networks, and access to local and practice specific data are needed to support an increased role for the OBGYN in the prevention of cardiovascular disease in women. Establishment of evidence-based screening and referral recommendations, specific to women across the age spectrum, may enable clinicians to capitalize on this important prevention opportunity. Longer term, and in concert with health care reform, a critical evaluation of the woman's place in the center of her medical home, rather than any one site, may yield improvements in health outcomes for women.