A Comprehensive Assessment of Family Physician Gender and Quality of Care A Cross-Sectional Analysis in Ontario, Canada

被引：70

作者：

Dahrouge, Simone ^{[1
,2
,3
,4
,5
]}

Seale, Emily ^{[2
,6
]}

Hogg, William ^{[1
,2
,3
,4
]}

Russell, Grant ^{[7
]}

Younger, Jaime ^{[5
,8
]}

Muggah, Elizabeth ^{[1
,2
]}

Ponka, David ^{[2
]}

Mercer, Jay ^{[9
]}

机构：

[1] Univ Ottawa, Dept Family Med, Ottawa, ON, Canada

[2] Bruyere Res Inst, CT Lamont Primary Hlth Care Res Ctr, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada

[3] Univ Ottawa, Inst Populat Hlth, Ottawa, ON, Canada

[4] Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, Canada

[5] Inst Clin Evaluat Sci, Ottawa, ON, Canada

[6] Queens Univ, Kingston, ON, Canada

[7] Monash Univ, Sch Primary Hlth Care, Southern Acad Primary Care Res Unit, Clayton, Vic, Australia

[8] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[9] Bruyere Family Med Ctr, Ottawa, ON, Canada

来源：

MEDICAL CARE | 2016年 / 54卷 / 03期

基金：

加拿大健康研究院;

关键词：

gender; continuity; quality; comprehensiveness; chronic disease management; access; family medicine; care; primary care; cancer screening; PATIENT-CENTERED COMMUNICATION; CLINICAL PREVENTIVE SERVICES; RISK-FACTOR CONTROL; HEALTH-CARE; DIABETES CARE; ADMINISTRATIVE DATA; WOMEN PHYSICIANS; DECISION-MAKING; REFERRAL RATES; SEX;

D O I：

10.1097/MLR.0000000000000480

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

100404 [儿少卫生与妇幼保健学];

摘要：

Background: Studies evaluating primary care quality across physician gender are limited to primary and secondary prevention. Objectives: Investigate the relationship between family physician gender and quality of primary care using indicators that cover 5 key dimensions of primary care. Research Design: Cross-sectional analysis using linked health administrative datasets (April 1, 2008 to March 31, 2010). Subjects: All family physicians working in the 3 main primary care models in the province of Ontario (Canada), providing general care and having a panel size > 1200. Measures: Indicators of cancer screening (3), chronic disease management (9), continuity (2), comprehensiveness (2), and access (5). Results: A total of 4195 physicians (31% female) were eligible. Adjusting for provider and patient factors, patients of female physicians were more likely to have received recommended cancer screening (odds ratios [95% confidence interval (CI)] (OR) range: 1.24 [1.18-1.30], 1.85 [1.78-1.92]) and diabetes management (OR: 1.04 [1.01-1.08], 1.28 [1.05-1.57]). They had fewer emergency room visits (rate ratio [95% CI] (RR) range: 0.83 [0.79-0.87]) and hospitalizations (RR: 0.89 [0.86-0.93]), and higher referrals (RR: 1.12 [1.09-1.14]). There was evidence of effect modification by patient gender (female vs. male) for hospitalization (RR: 0.74 [0.70-0.79] vs. 0.96 [0.90-1.02]) and emergency room visits (RR: 0.84 [0.81-0.88] vs. 0.98 [0.94-1.01]). Lower emergency room visits were also more evident in more complex patients of female physicians. There were no significant differences in the continuity or comprehensiveness measures. Conclusions: The indicators assessed in this study point to a benefit for patients under the care of female physicians. Potential explanations are discussed.

引用

页码：277 / 286

页数：10

共 56 条

[1]

Relationship between social inequalities and ambulatory care-sensitive hospitalizations persists for up to 9 years among children born in a major Canadian urban center [J].