医患性别一致性与糖尿病心血管疾病风险因素控制和治疗的关联。
The association of patient-physician gender concordance with cardiovascular disease risk factor control and treatment in diabetes.
机构信息
Division of Research, Kaiser Permanente Medical Care Program, Northern California, Oakland, California 94612, USA.
出版信息
J Womens Health (Larchmt). 2009 Dec;18(12):2065-70. doi: 10.1089/jwh.2009.1406.
BACKGROUND
Gender concordance between patients and their physicians is related to prevention screening and other quality indicators. Research suggests female physicians may place greater emphasis on preventive care than male physicians; however, little is known about whether physician gender and patient-physician gender concordance are associated with cardiovascular disease (CVD) risk factor levels and treatment. Our objective was to examine associations between patient gender, physician gender, and their interaction with CVD risk factor control, medication adherence, and treatment intensification in diabetes.
METHODS
In this study, 157,458 Kaiser Permanente Northern California adult diabetes patients with a primary care physician (PCP) were assessed for above target levels of hemoglobin A1c (HbA1c) (>or=8%), low-density lipoprotein cholesterol (LDL-C) (>or=100 mg/dL), and systolic blood pressure (SBP>or=130 mm Hg) in 2005. Medication adherence and appropriate CVD treatment intensification were assessed using pharmacy data. Probit models assessed the adjusted marginal effects of patient gender, PCP gender, and their interaction on control, adherence, and intensification.
RESULTS
Female patients had lower adjusted rates of LDL-C (46% vs. 55%, p<0.001) and SBP control (52% vs. 60%, p<0.001) than males. Female patients of female PCPs had the highest adjusted rates of HbA1c control of the four patient-physician gender dyads (70% vs. 66%-68%, p<0.05). Male patients were more likely than female patients to receive treatment intensification for high SBP (60% vs. 57%, p<0.001). Female PCPs were more likely than their male counterparts to intensify therapy for hyperlipidemia and hypertension.
CONCLUSIONS
Patient and physician gender and gender concordance are modestly associated with CVD risk factor control and treatment in diabetes. Further understanding of these differences could lead to improved CVD outcomes for women.
背景
患者与医生的性别一致性与预防筛查和其他质量指标有关。研究表明，女性医生可能比男性医生更注重预防保健；然而，对于医生的性别和患者与医生的性别一致性是否与心血管疾病（CVD）风险因素水平和治疗有关，人们知之甚少。我们的目的是研究患者性别、医生性别及其相互作用与糖尿病患者心血管疾病风险因素控制、药物依从性和治疗强化之间的关系。
方法
在这项研究中，评估了 157458 名在 2005 年患有主要保健医生（PCP）的加利福尼亚北部 Kaiser Permanente 成年糖尿病患者的糖化血红蛋白（HbA1c）>8%、低密度脂蛋白胆固醇（LDL-C）>100mg/dL 和收缩压（SBP）>130mmHg 等指标。使用药房数据评估药物依从性和适当的 CVD 治疗强化情况。采用概率单位模型评估患者性别、PCP 性别及其相互作用对控制、依从性和强化的调整后的边缘效应。
结果
女性患者的 LDL-C（46%对 55%，p<0.001）和 SBP 控制率（52%对 60%，p<0.001）均低于男性。在四个患者-医生性别组合中，女性患者的女性 PCP 拥有最高的 HbA1c 控制率（70%对 66%-68%，p<0.05）。与女性患者相比，男性患者更有可能接受强化治疗以控制高血压（60%对 57%，p<0.001）。与男性 PCP 相比，女性 PCP 更有可能强化治疗血脂异常和高血压。
结论
患者和医生的性别以及性别一致性与糖尿病患者的 CVD 风险因素控制和治疗有一定的相关性。进一步了解这些差异可能会改善女性的 CVD 结局。
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