Patterns of care for women with uterine leiomyoma.

摘要

Leiomyomata uteri, also know as uterine fibroids, are the most common tumors of the female reproductive tract. Although the majority of leiomyomata are asymptomatic, more than 30% of affected women suffer from one or more symptoms including abnormal uterine bleeding, anemia, pelvic pain, pelvic pressure, urinary problems and infertility. Our objective was to identify patient-, physician- and hospital-related factors that are associated with patterns of care for this condition.; Two approaches were used to identify determinants of treatment among women with a primary diagnosis of leiomyoma. First, we used administrative data from the Massachusetts Health Data Consortium to identify determinants of hysterectomy in Massachusetts women over a two year period. Second, we conducted a chart review study of leiomyoma patients at Baystate Medical Center in Springfield, Massachusetts to identify determinants of treatment pattern during the same time period.; Both sets of analyses identified factors associated with treatment decision. In the analysis of the Massachusetts Health Data Consortium data, significant determinants of hysterectomy included older age, White or Hispanic race, hospital location outside of Boston and hospital lacking specialized OB/GYN services. In the analysis using hospital records, we found that younger age; Black race, insurance through an HMO, more recent physician graduation, and nulliparity were significantly associated with a conservative treatment approach. Presence of symptoms including heavy bleeding and urinary problems were significantly associated with receiving no conservative treatment prior to hysterectomy.; This pair of studies has clearly shown that a variety of clinical, patient, hospital and physician characteristics are important determinants of treatment in women with a primary diagnosis of leiomyoma. Future research should focus on examining the interrelationships of these various factors in determining patterns of care for various sub-sets of patients diagnosed with leiomyomata. New research efforts should be centered in large physician practice groups where longitudinal studies of patients can be used to assess the extent to which physician and patient attitudes and behaviors influence the decision making process with regard to this condition.