School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.
Heart. 2019 Dec;105(24):1898-1904. doi: 10.1136/heartjnl-2019-315134. Epub 2019 Jul 23.
To determine whether sex differences exist in the management of patients with a history of coronary heart disease (CHD) in primary care.
General practice records of patients aged ≥18 years with a history of CHD in a large general practice dataset in Australia, MedicineInsight, were analysed. Sex-specific, age-standardised proportions of patients prescribed with recommended medications; assessed for cardiovascular risk factors; and achieved treatment targets according to the General Practice Management Plan were reported.
Records of 130 926 patients (47% women) from 438 sites were available from 2014 to 2018. Women were less likely to be prescribed with recommended medications (prescribed ≥3 medications: women 44%, men 61%; p<0.001). Younger patients, especially women aged <45 years, were substantially underprescribed (aged <45 years prescribed ≥3 medications: women 2%, men 8%; p<0.001). Lower proportions of women were assessed for cardiovascular risk factors (blood test for lipids: women 70%-76%, men 77%-81%; p<0.001). Body size was not commonly assessed (body mass index: women 59%, men 62%; p<0.001; waist: women 23%, men 25%; p<0.001). Higher proportions of women than men achieved targets for most risk factors (achieved ≥4 targets in patients assessed for all risk factors: women 82%, men 76%).
Gaps in preventative management including prescription of indicated medications and risk factor monitoring have been reported from the late 1990s and this large-scale general practice data analysis indicate they still persist. Moreover, the gap is larger in women compared to men. We need new ways to address these gaps and the sex inequity.
在初级保健中，确定有冠心病（CHD）病史的患者的管理是否存在性别差异。
分析澳大利亚大型普通实践数据集 MedicineInsight 中年龄≥18 岁有 CHD 病史的患者的普通实践记录。报告了按性别划分、年龄标准化的推荐药物处方比例；评估心血管危险因素；并根据一般实践管理计划达到治疗目标的情况。
2014 年至 2018 年期间，来自 438 个地点的 130926 名患者（47%为女性）的记录可用。女性服用推荐药物的可能性较低（服用≥3 种药物：女性 44%，男性 61%；p<0.001）。年轻患者，尤其是<45 岁的女性，处方明显不足（<45 岁服用≥3 种药物：女性 2%，男性 8%；p<0.001）。女性评估心血管危险因素的比例较低（血脂血液检查：女性 70%-76%，男性 77%-81%；p<0.001）。身体大小通常未被评估（体重指数：女性 59%，男性 62%；p<0.001；腰围：女性 23%，男性 25%；p<0.001）。与男性相比，更多的女性达到了大多数危险因素的目标（评估所有危险因素的患者达到≥4 个目标：女性 82%，男性 76%）。
从 20 世纪 90 年代末以来，已有报告称预防性管理存在差距，包括开具指示药物和监测危险因素，而这项大规模的普通实践数据分析表明，这些差距仍然存在。此外，女性与男性相比差距更大。我们需要新的方法来解决这些差距和性别不平等问题。
