Naicker Kiyuri, Liddy Clare, Singh Jatinderpreet, Taljaard Monica, Hogg William
Bruyère Research Institute, C,T, Lamont Primary Health Care Research Centre, 43 Bruyère St, Annex E, Ottawa, Ontario K1N 5C8, Canada.
BMC Fam Pract. 2014 Jun 18;15:123. doi: 10.1186/1471-2296-15-123.
Women are disproportionately affected by cardiovascular disease, often experiencing poorer outcomes following a cardiovascular event. Evidence points to inequities in processes of care as a potential contributing factor. This study sought to determine whether any sex differences exist in adherence to process of care guidelines for cardiovascular disease within primary care practices in Ontario, Canada.
This is a secondary analysis of pooled cross-sectional baseline data collected through a larger quality improvement initiative known as the Improved Delivery of Cardiovascular Care (IDOCC). Chart abstraction was performed for 4,931 patients from 84 primary care practices in Eastern Ontario who had, or were at high risk of, cardiovascular disease. Measures examining adherence to guidelines associated with nine areas of cardiovascular care (coronary artery disease, peripheral vascular disease (PVD), stroke/transient ischemic attack, chronic kidney disease, diabetes, dyslipidemia, hypertension, smoking cessation, and weight management) were collected. Multivariable logistic regression analysis was performed to evaluate sex differences, adjusting for age, physician remuneration, and rurality.
Women were significantly less likely to have their lipid profiles taken (OR=1.17, 95% CI 1.03-1.33), be prescribed lipid lowering medication for dyslipidemia (OR=1.54, 95% CI 1.20-1.97), and to be prescribed ASA following stroke (OR=1.56, 95% CI 1.39-1.75). Women with PVD were significantly less likely to be prescribed ACE inhibitors and/or angiotensin receptor blockers (OR=1.74, 95% CI 1.25-2.41) and lipid lowering medications (OR=1.95, 95% CI 1.46-2.62) or ASA (OR=1.59, 95% CI 1.43-1.78). However, women were more likely to have two blood pressure measurements taken and to be referred to a dietician or weight loss program. Male patients with diabetes were less likely to be prescribed glycemic control medication (OR=0.84, 95% CI 0.74-0.86).
Sex disparities exist in the quality of cardiovascular care in Canadian primary care practices, which tend to favour men. Women with PVD have a particularly high risk of not receiving appropriate medications. Our findings indicate that improvements in care delivery should be made to address these issues, particularly with regard to the prescribing of recommended medications for women, and preventive measures for men.
心血管疾病对女性的影响尤为严重，心血管事件发生后，她们的预后往往更差。有证据表明，护理过程中的不平等是一个潜在的促成因素。本研究旨在确定在加拿大安大略省的初级保健机构中，心血管疾病护理过程指南的遵循情况是否存在性别差异。
这是一项对汇总的横断面基线数据进行的二次分析，这些数据是通过一项名为“改善心血管护理服务”（IDOCC）的更大规模质量改进计划收集的。对安大略省东部84家初级保健机构中4931名患有心血管疾病或有心血管疾病高风险的患者进行了病历摘要分析。收集了与心血管护理九个领域（冠状动脉疾病、外周血管疾病（PVD）、中风/短暂性脑缺血发作、慢性肾病、糖尿病、血脂异常、高血压、戒烟和体重管理）相关的指南遵循情况的测量指标。进行多变量逻辑回归分析以评估性别差异，并对年龄、医生薪酬和农村地区进行了调整。
女性进行血脂检测的可能性显著降低（比值比[OR]=1.17，95%置信区间[CI] 1.03 - 1.33），因血脂异常而开具降脂药物的可能性降低（OR = 1.54，95% CI 1.20 - 1.97），中风后开具阿司匹林的可能性降低（OR = 1.56，95% CI 1.39 - 1.75）。患有外周血管疾病的女性开具血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂的可能性显著降低（OR = 1.74，95% CI 1.25 - 2.41），开具降脂药物的可能性降低（OR = 1.95，95% CI 1.46 - 2.62）或开具阿司匹林的可能性降低（OR = 1.59，95% CI 1.43 - 1.78）。然而，女性进行两次血压测量以及被转诊至营养师或减肥项目的可能性更高。患有糖尿病的男性患者开具血糖控制药物的可能性降低（OR = 0.84，95% CI 0.74 - 0.86）。
加拿大初级保健机构中，心血管护理质量存在性别差异，且往往更有利于男性。患有外周血管疾病的女性未接受适当药物治疗的风险尤其高。我们的研究结果表明，应改进护理服务以解决这些问题，特别是针对女性开具推荐药物以及针对男性采取预防措施。
