Gender inequity in the provision of care for hip disease: population-based cross-sectional study
Gender inequity in the provision of care for hip disease: population-based cross-sectional study
复制标题
DOI：
10.1016/j.joca.2009.12.010
复制
发表时间：
2010-05-01
影响因子：
7
通讯作者：
Dieppe, P. A.
中科院分区：
文献类型：
--
作者：
Jueni, P.;Low, N.;Dieppe, P. A.
目的：探讨全髋关节置换术护理过程中的性别差异。方法：我们在埃文和萨默塞特进行了一项基于人群的横断面研究，研究对象为26,046名年龄在35岁及以上的个体。参与者完成了一份调查问卷，询问在全髋关节置换术过程中的五个里程碑的护理提供情况。那些报告患有髋关节疾病的人被邀请进行临床检查。我们估计了为女性和男性提供护理的比值比（ORs）[95%置信区间（CI）]。结果：3169人报告髋关节疼痛，2018人被邀请进行临床检查，1405人参加了临床检查（69.6%）。在调整年龄和疾病严重程度后，女性咨询全科医生的可能性低于男性（OR 0.78, 95%-CI 0.61-1.00），在前一年接受髋关节疼痛药物治疗的可能性与男性相同（OR 0.96, 95%-CI 0.74-1.24），但转诊专科护理的可能性低于男性（OR 0.53, 95%-CI 0.40-0.70），咨询骨科医生的可能性低于男性（OR 0.50, 95%-CI 0.32-0.78），或等待全髋关节置换术的可能性低于男性(OR 0.41，95% ci 0.20 - -0.87)。746名从全科医生那里寻求治疗的人，在调整了手术的意愿和健康状况后，差异仍然存在。结论：在英格兰，髋骨疾病护理的提供存在性别不平等，这并不能完全由寻求护理和治疗偏好的性别差异来解释。全科医生转诊到专科护理的差异可能在不知不觉中助长了这种不平等。对提供者和患者提供关于髋关节置换术的可获得性、益处和风险的准确信息，以及继续教育以确保临床医生解释和纠正患者的假设，有助于减少不平等现象。(C) 2010年国际骨关节炎研究学会。Elsevier Ltd.出版。版权所有。
Objectives: To examine gender differences along the care pathway to total hip replacement.Methods: We conducted a population-based cross-sectional study of 26,046 individuals aged 35 years and over in Avon and Somerset. Participants completed a questionnaire asking about care provision at five milestones on the pathway to total hip replacement. Those reporting hip disease were invited to a clinical examination. We estimated odds ratios (ORs) [95% confidence intervals (CI)] for provision of care to women compared with men.Results: 3169 people reported hip pain, 2018 were invited for clinical examination, and 1405 attended (69.6%). After adjustment for age and disease severity, women were less likely than men to have consulted their general practitioner (OR 0.78, 95%-CI 0.61-1.00), as likely as men to have received drug therapy for hip pain in the previous year (OR 0.96, 95%-CI 0.74-1.24), but less likely to have been referred to specialist care (OR 0.53, 95%-CI 0.40-0.70), to have consulted an orthopaedic surgeon (OR 0.50, 95%-CI 0.32-0.78), or to be on a waiting list for total hip replacement (OR 0.41, 95%-CI 0.20-0.87). Differences remained in the 746 people who had sought care from their general practitioner, and after adjustment for willingness and fitness for surgery.Conclusions: There are gender inequalities in provision of care for hip disease in England, which are not fully accounted for by gender differences in care seeking and treatment preferences. Differences in referral to specialist care by general practitioners might unwittingly contribute to this inequity. Accurate information about availability, benefits and risks of hip replacement for providers and patients, and continuing education to ensure that clinicians interpret and correct patients' assumptions could help reduce inequalities. (C) 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.