Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
BMJ Open. 2019 Sep 6;9(9):e027296. doi: 10.1136/bmjopen-2018-027296.
The objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.
A nation-wide cross-sectional study was performed in 2016.
The study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.
Multilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.
48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.
Female GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.
我们的研究目的是（1）调查匈牙利普通医生（GP）的性别与初级保健质量之间的关系，具体涉及 GP 绩效的过程指标，（2）评估性别影响的大小。
2016 年进行了一项全国性的横断面研究。
该研究涵盖了匈牙利所有负责成年人初级保健（PHC）的普通医疗实践（n=4575）。他们的私人执业中的所有 GP 都是个体从业者。
多水平逻辑回归模型用于分析 GP 性别与 PHC 过程指标之间的关联，并计算归因比例（AP）。
研究中 48%的 GP（n=2213）为女性。与男性 GP 相比，女性 GP 在评估的八项指标中的七项指标中提供的护理率明显更高。调整实践、医生和患者因素后，GP 性别与血红蛋白 A1c（HbA1c）测量相关：OR=1.18，95%置信区间（1.14 至 1.23）；血清肌酐测量：OR=1.14，95%置信区间（1.12 至 1.17）；血脂测量：OR=1.14，95%置信区间（1.11 至 1.16）；眼部检查：OR=1.06，95%置信区间（1.03 至 1.08）；乳房 X 光筛查：OR=1.05，95%置信区间（1.03 至 1.08）；慢性阻塞性肺疾病患者的管理：OR=1.05，95%置信区间（1.01 至 1.09）和综合指标：OR=1.08，95%置信区间（1.07 至 1.1），综合了每个指标的护理事件数量和目标人群的大小。特定指标的 AP 从流感免疫接种的 0.97%（95%CI 0.49%至 1.44%）到眼部检查的 8.04%（95%CI 7.4%至 8.67%）不等。
女性 GP 性别是获得更高质量护理的独立预测因素。服务质量方面的实际性别效应似乎相当显著。质量改进中应更加关注性别效应背后的因素，特别是在初级保健以个体执业为组织形式的国家。
