Gowin Ewelina, Avonts Dirk, Horst-Sikorska Wanda, Ignaszak-Szczepaniak Magdalena, Michalak Michał
Department of Family Medicine, University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland.
Qual Prim Care. 2009;17(5):343-50.
General practitioners' (GPs') time and resources for preventive services needs to be delivered equitably. We aimed to study the effect of patients' gender on the delivery of preventive procedures to adult patients aged 40 years and over.
An observational study was performed in primary care surgeries in Wielkopolska (Poland) as a part of the Improving Quality in Primary Care (PIUPOZ) programme carried out by Family Medicine Department of the University of Medical Sciences, Poznan. Trained observers directly observed GPs in their office, to register preventive procedures performed during the consultation and in the previous year (via the medical record) in patients aged 40 years and over.
A total of 1073 preventive procedures were registered among 450 patients (267 women and 183 men) by 113 doctors in one year. The most common were serum glucose, blood pressure and total cholesterol measurements. Six procedures were offered to less than 10% of patients: dietary advice, tobacco use and alcohol screening, exercise counselling, body mass index (BMI) recording, and waist measurement. Men were more likely to receive tobacco use and alcohol screening and BMI measurement, while more women were offered a total cholesterol screen.
The annual delivery rate of preventive procedures in patients aged 40 years and above is below the recommended level set by the Polish Ministry of Health. Procedures based on clinical examinations or laboratory tests were offered and performed more frequently than lifestyle advice. More men than women received preventive services for tobacco use or alcohol screening and BMI measurements. Patients' gender and physicians' engagement may influence GPs' preventive attitude and performance. These elements should be incorporated in the development of guidelines concerning prevention in primary care.
全科医生用于预防服务的时间和资源需要公平分配。我们旨在研究患者性别对40岁及以上成年患者预防措施实施情况的影响。
作为波兹南医科大学家庭医学系开展的“提高初级医疗质量”（PIUPOZ）项目的一部分，在波兰大波兰省的基层医疗诊所进行了一项观察性研究。经过培训的观察员在医生办公室直接观察全科医生，记录40岁及以上患者在会诊期间以及上一年（通过病历）接受的预防措施。
113名医生在一年内对450名患者（267名女性和183名男性）进行了共计1073项预防措施登记。最常见的是血糖、血压和总胆固醇测量。不到10%的患者接受了六项预防措施：饮食建议、烟草使用和酒精筛查、运动咨询、体重指数（BMI）记录以及腰围测量。男性更有可能接受烟草使用和酒精筛查以及BMI测量，而更多女性接受了总胆固醇筛查。
40岁及以上患者预防措施的年度实施率低于波兰卫生部设定的推荐水平。基于临床检查或实验室检测的预防措施比生活方式建议提供和实施得更频繁。接受烟草使用或酒精筛查以及BMI测量等预防服务的男性多于女性。患者性别和医生的参与度可能会影响全科医生的预防态度和表现。这些因素应纳入基层医疗预防指南的制定中。
