Gender inequalities in COPD decision-making in primary care
Gender inequalities in COPD decision-making in primary care
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DOI：
10.1016/j.rmed.2016.03.017
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发表时间：
2016-05-01
影响因子：
4.3
通讯作者：
Luna del Castillo, Juan de Dios
中科院分区：
文献类型：
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作者：
Delgado, Ana;Saletti-Cuesta, Lorena;Luna del Castillo, Juan de Dios
背景：慢性阻塞性肺疾病是一种常见的严重疾病，对女性的影响越来越大。目的：分析相同COPD患者的初级保健决策与家庭医生(FP)性别的关系。方法：对457名安达卢西亚FP患者进行横断面、多中心研究，采用以男性或女性患者为对象的自填式COPD调查问卷，有四个变量用于临床推理：“吸烟是最重要的危险因素(RF)”、“肺量测定的顺序”、“最有可能诊断的COPD”和“转诊”。结果：有效率为67.4%(308/457)。在对4个FP性别患者性别对偶的分析中，在女性(95.6%对67.1%)和男性(79.8%对62.5%)FP中，男性比女性更常被认为是优先的RF。女性(84.4%对49.9%)和男性(78.5%对57.8%)最有可能诊断为COPD。男性FP比女性更频繁地要求进行肺活量测定(68.1%对46.8%)。男性和女性患者在转诊方面没有差异。男性FP比女性FP更倾向于将烟草视为男性的首选RF(p=002)。女性FP比男性FP更倾向于推荐男性(22.5%比8%)。结论：在我们的环境中，COPD初级保健可能存在性别不平等。女性患者的诊断和治疗努力似乎较低。男性和女性FP仅在照顾男性患者方面有所不同，这表明FP性别与患者性别之间存在交互作用。(C)2016爱思唯尔有限公司。保留所有权利。
Background: COPD is a frequent severe illness that increasingly affects females. Gender inequalities have been reported in COPD care.Objective: To analyze decision-making in primary care for men and women with identical COPD as a function of the gender of the family physician (FP).Methods: Cross-sectional, multicenter study in 457 Andalusian FPs, using a self-administered vignette-based questionnaire on COPD featuring a male or female patient, with four variables on clinical reasoning: "tobacco as most important risk factor (RF)", "ordering of spirometry", "COPD as most likely diagnosis", and "referral". Multilevel logistic regression analysis.Results: Response rate was 67.4% (308/457). In analysis of the four FP gender-patient gender dyads, tobacco was more frequently considered as priority RF for the man than for the woman in the vignette by female (95.6% vs. 67.1%) and male (79.8% vs. 62.5%) FPs. COPD was more frequently the most likely diagnosis for the man versus woman by female (84.4% vs. 49.9%) and male (78.5% vs. 57.8%) FPs. Male FPs more frequently ordered spirometry for the man versus woman (68.1% vs. 46.8%). There were no differences in referral between male and female patients. Male FPs were more likely than female FPs to consider tobacco as priority RF for the man (p = 002). Female FPs were more likely than male FPs to refer the man (22.5% vs. 8%).Conclusions: There may be gender inequalities in primary care for COPD in our setting. Diagnostic and therapeutic efforts appear lower in female patients. Male and female FPs only differed in care of the male patient, indicating FP gender-patient gender interaction. (C) 2016 Elsevier Ltd. All rights reserved.