Primary Cerebrovascular Preventive Care in Women: Primary Stroke Prevention by Obstetrician/Gynecologists
Aditya Chanpura1, Nadege Gilles2, Sarah A. Friedman2, Rachel Asaeda2, Irina Kharisova2, Moyouri Bhattacharjee2, Angelika Gruessner3, Steven R. Levine2
1School of Public Health, SUNY Downstate Medical Center, 2SUNY Downstate Medical Center, 3SUNY Downstate Health Sciences University
Objective:
a)Evaluate stroke preventive care provided by ObGyn physicians as reported by women within our predominantly urban, Caribbean black population of central Brooklyn, and (b) patient perception of stroke prevalence.
Background:
Many women identify or utilize a Obstetrician- Gynecologist (ObGyn) as their primary care physician (PCP). A woman is twice as likely to die from a stroke than breast cancer. One potential reason for the high burden of stroke in women may be sub optimal primary stroke preventive care.
Design/Methods:
An IRB-approved, prospective, outpatient, self-administered survey of 115 participants from the SUNY Downstate Health Sciences University ObGyn clinic between 40 and 55 years of age, who acknowledged their ObGyn as their PCP. Descriptive statistics were generated for all patient characteristics and survey answers. Chi- square tests were used to assess associations between categorial variables, with p=.05 as the threshold.
Results:
The mean age of participants was 46.9 +/- 5.4 years , 88% identified as Black/African American, 74% graduated high school, and 56% had a household income below the NYC median average [$69,717]. For preventative care, ObGyn physicians evaluated weight (40%), blood pressure (37%), presense of diabetes (11%) and cholesterol levels (11%). Of participants with stroke risk factors (high blood pressure, diabetes, elevated cholesterol, overweight, alcohol and tobacco use) 52% percent were provided patient education for lifestyle changes (26% were given referrals, and 26% were given prescription medication). Over 50% of the participating women believed that strokes occurred more frequently in women. Of the participants with stroke risk factors, only 8% perceived stroke as one of the leading causes of death.
Conclusions:
Our survey data suggest that ObGyn physicians who are identified by their patients as their PCP incompletely screen for well-established stroke risk factors. Future, larger studies should provide comparative data to internists and family medicine physicians as well as data derived from physicians’ medical records.