Buja Alessandra, Fusinato Riccardo, Claus Mirko, Gini Rosa, Braga Mario, Cosentino Mimma, Boccuzzo Giovanna, Francesconi Paolo, Baldo Vincenzo, Bellentani Mariadonata, Damiani Gianfranco
1Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health,University of Padua,Padova,Italy.
2Department of Statistical Sciences,University of Padua,Padova,Italy.
Prim Health Care Res Dev. 2018 Nov;19(6):616-621. doi: 10.1017/S1463423618000221. Epub 2018 Jun 21.
A major shift in the gender of the medical-doctor workforce is now underway, and all over the world it is expected that an average 65% of the medical workforce will be women by 2030. In addition, an aging population means that chronic diseases, such as diabetes, are becoming more prevalent and the demand for care is rising. There is growing evidence of female physicians performing better than male physicians.AimOur study aimed to investigate whether any differences in diabetes process indicators are associated with gender, and/or the interaction between gender and different organizational models.Design and settingA population-based cross-sectional analysis was conducted on a large data set obtained by processing the public health administration databases of seven Italian local health units (LHUs). The seven LHUs, distributed all over the Italian peninsula in seven different regions, took part in a national project called MEDINA, with the focus on chronic disease management in primary care (PC).
A total score was calculated for the average performance in the previously listed five indicators, representing global adherence to a quality management of patients with diabetes. A multilevel analysis was applied to see how LHUs affected the outcome. A quantile regression model was also fitted.
Our study included 2287 Italian general practitioners (586 of them female) caring for a total of 2 646 059 patients. Analyzing the performance scores confirmed that female general practitioners obtained better results than males. The differences between males and females were stronger on the 25th and 75th percentiles of the score than on the median values. The interaction between gender and LHU was not significant.
Our study evidenced that female physicians perform better than males in providing PC for diabetes independently by the different organizational models. Further research to understand the reasons for these gender differences is needed.
目前，医学从业人员的性别结构正在发生重大转变，预计到2030年，全球医学从业人员中女性的平均占比将达到65%。此外，人口老龄化意味着糖尿病等慢性病日益普遍，护理需求不断上升。越来越多的证据表明，女医生的表现优于男医生。
我们的研究旨在调查糖尿病诊疗过程指标的差异是否与性别及性别与不同组织模式之间的相互作用有关。
基于意大利七个地方卫生单位（LHU）的公共卫生管理数据库进行了一项基于人群的横断面分析。这七个LHU分布在意大利半岛的七个不同地区，参与了一个名为MEDINA的全国性项目，重点是初级保健（PC）中的慢性病管理。
计算了上述五个指标的平均表现总分，代表对糖尿病患者质量管理的整体依从性。应用多层次分析来观察LHU如何影响结果。还拟合了分位数回归模型。
我们的研究纳入了2287名意大利全科医生（其中586名女性），他们共照顾了2646059名患者。对表现得分的分析证实，女性全科医生的结果优于男性。得分的第25百分位数和第75百分位数上男女之间的差异比中位数上的差异更大。性别与LHU之间的相互作用不显著。
我们的研究表明，在提供糖尿病初级保健方面，女医生的表现优于男医生，且不受不同组织模式的影响。需要进一步研究以了解这些性别差异的原因。
