Physician and patient gender concordance and the delivery of comprehensive clinical preventive services
Physician and patient gender concordance and the delivery of comprehensive clinical preventive services
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DOI：
10.1097/01.mlr.0000160418.72625.1c
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发表时间：
2005-05-01
期刊：
影响因子：
3
通讯作者：
Gilchrist, V
中科院分区：
文献类型：
--
作者：
Flocke, SA;Gilchrist, V
背景：了解患者和医生性别在提供预防性服务方面的作用对于确定增加预防性服务提供的策略具有重要意义。我们试图克服先前研究的方法学局限性，检验患者与医生性别互动与提供预防性筛查、咨询和免疫服务之间的关系。方法：在这项横断面研究中，研究护士直接观察了 3256 名连续成年患者就诊于 138 名家庭医生。美国预防服务工作组 (USPSTF) 建议的筛查、健康行为咨询和免疫服务的提供情况是通过直接观察和病历审查进行评估的。采用多水平回归分析来检验医生和患者性别与预防性服务提供的交互作用，控制患者年龄、保险类型、过去 2 年就诊次数和医生年龄。结果：医生和患者性别的交互作用与性别中立筛查、咨询或免疫接种的提供没有显着相关。女医生的患者比男医生的患者更了解咨询服务（P < 0.01）和免疫接种（P < 0.05）。与医生性别无关，男性患者在咨询和免疫接种方面更了解最新情况（P < 0.01）。结论：医生与患者的性别一致性与提供更多预防性服务无关。相反，女医生为所有患者提供更多咨询和免疫服务。先前的研究显示，女医生进行性别筛查的比例较高，这可能表明女医生总体上有更大的预防导向，而不是性别一致性的具体好处。
Background: Understanding the role of patient- and physician-gender on delivery of preventive services has important implications for identifying strategies to increase preventive service delivery. We attempt to overcome methodological limitations of previous studies in examining the association of the patient-physician gender interaction on the delivery of preventive screening, counseling, and immunization services.Methods: In this cross-sectional study, research nurses directly observed 3256 consecutive adult patient visits to 138 family physicians. Delivery of gender neutral US Preventive Services Task Force (USPSTF) recommended screening, health behavior counseling, and immunization services was assessed by direct observation and medical record review. Multilevel regression analyses were used to test the interaction effect of physician and patient gender with preventive service delivery, controlling for patient age, insurance type, number of office visits in the past 2 years and physician age.Results: The interaction effect of physician and patient gender was not significantly associated with delivery of gender neutral screening, counseling, or immunizations. Patients of female physicians were more up-to-date on counseling services (P < 0.01) and immunizations (P < 0.05) than patients of male physicians. Male patients, independent of physician gender, were more up-to-date on counseling and immunizations (P < 0.01).Conclusions: Physician-patient gender concordance is not associated with delivery of more preventive services. Rather, female physicians provide more counseling and immunization services to all of their patients. Previous research showing higher rates of gender-specific screening achieved by women physicians may have been an indication of an overall greater prevention orientation among women physicians rather than a specific benefit of gender concordance.