ACOG Stresses Role of Ob/Gyns in Preventive Care For Women

Troy Brown, RN

October 01, 2018

Updated guidelines from the American College of Obstetricians and Gynecologists (ACOG) stress the role of obstetrician/gynecologists (ob/gyns) in providing preventive care for women throughout their lifetime. The recommendations coincide with the release of a new Well-Woman Chart from the ACOG-led Women's Preventive Services Initiative (WPSI).

The updated clinical opinion from the ACOG Committee on Gynecologic Practice, entitled "The Well-Woman Visit," was published in the October issue of Obstetrics and Gynecology and replaces a committee opinion released in August 2012. It reflects "updated guidance on components of the physical examination and new sources for well-woman preventive services," the authors write.

Christopher Zahn, MD, ACOG vice president of Practice Activities, said in an ACOG news release: "To better address the specific and unique needs of each woman more comprehensively, preventive services and corresponding recommendations have expanded and further emphasize the role of the ob/gyn."

"These resources strive to support ob/gyns and other women's healthcare providers as they navigate these changes by providing well-organized and comprehensive sources of women's preventive care recommendations."

"Increasingly, women look to their ob/gyn for both reproductive and primary healthcare, which creates an exciting opportunity for ob/gyns to build even deeper and longer lasting relationships with our patients," stressed Zahn.

"An ob/gyn may care for a patient as an adolescent, through her reproductive years, and as she experiences menopause and beyond. These resources are here to ensure that these ongoing updates to well-woman recommendations are manageable and positive for women's healthcare providers and the women who are in their care."

Care for the Whole of a Woman's Life

The Well-Woman Chart is a comprehensive summary of preventive services recommendations for women from the WPSI, US Preventive Services Task Force, and Bright Futures. It is organized by age group, beginning at age 13 years and ending at age 75 years, with services categorized by general health, infectious diseases, and cancer. The Well-Woman Chart also outlines preventive services for women during pregnancy and the postpartum period and lists criteria for selective screening of all women.

ACOG emphasizes the need for physicians to take a comprehensive history at the well-woman visit, including updating a woman's family history as part of risk assessment. Screening, evaluation, and counseling, as well as immunizations, should be individualized for each woman on the basis of age and risk factors.

Not every component of a physical exam — such as cervical cancer screening or a pelvic examination — will be needed at each well-woman visit, say the authors; however, the visit provides a valuable opportunity for ob/gyns to counsel women about healthy lifestyle choices and avoiding risk behaviors such as smoking, poor diet, and lack of physical activity.

"The interval for specific individual services may differ for individual patients, and the scope of services provided may vary in different ambulatory care settings," the guideline authors explain.

Decisions about when and how often to screen should be based on current evidence and be part of a shared decision-making process between the woman and her healthcare provider.

And clinicians should discuss with women of reproductive age their current and future reproductive plans so they can provide care that is consistent with those plans, the guidelines recommend.

Bone health, vulvovaginal symptoms, and sexual health should also be discussed with women throughout the lifetime but are often overlooked, the authors write. And women who are perimenopausal and postmenopausal need periodic well-woman examinations as well as younger women.

Women's preventive care recommendations have changed in the last 10 years in ways that have "altered the focus of a well-woman visit for both patients and providers," according to the news release.

"These include a move away from the yearly Pap test, an increase in the popularity of long-acting reversible contraceptive methods, and most recently, ACOG's updated guidance regarding the performance of the pelvic exam.

It may not be possible for all recommended services to be provided during one visit or by one healthcare provider; therefore, women's preventive care needs may be best met by team-based care that includes ob/gyns, physician assistants, nurse practitioners, and other healthcare professionals.

Additional resources are available on the ACOG website.

Obstet Gynecol. 2018;132:e181-e186. ACOG Committee Opinion No. 755.

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