全科医生的性别与诊断程序的使用：法国培训实践中的一项横断面研究。

General practitioner gender and use of diagnostic procedures: a French cross-sectional study in training practices.

机构信息

Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France.

INSERM CESP, Université Paris-Saclay, Saint-Aubin, France.

出版信息

BMJ Open. 2022 May 6;12(5):e054486. doi: 10.1136/bmjopen-2021-054486.

DOI:10.1136/bmjopen-2021-054486

PMID:35523487

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9083381/

Abstract

OBJECTIVES

The acceleration in the number of female doctors has led to questions about differences in how men and women practice medicine. The aim of this study was to assess the influence of general practitioner (GP) gender on the use of the three main categories of diagnostic procedures-clinical examinations, laboratory tests and imaging investigations.

DESIGN

Cross-sectional nationwide multicentre study.

SETTING

French training general practices.

PARTICIPANTS

The patient sample included all the voluntary patients over a cumulative period of 5 days per office between November 2011 and April 2012. The GP sample included 85 males and 43 females.

METHODS

54 interns in general practice, observing their GP supervisors, collected data about the characteristics of GPs and consultations, as well as the health problems managed during the visit and the processes of care associated with them. Using hierarchical multilevel mixed-effect logistic regression models, we performed multivariable analyses to assess differences in each of the three main categories of diagnostic procedures, and two specific multivariable analyses for each category, distinguishing screening from diagnostic or follow-up procedures. We searched for interactions between GP gender and patient gender or type of health problem managed.

RESULTS

This analysis of 45 582 health problems managed in 20 613 consultations showed that female GPs performed more clinical examinations than male GPs, both for screening (OR 1.75; 95% CI 1.19 to 2.58) and for diagnostic or follow-up purposes (OR 1.41; 95% CI 1.08 to 1.84). Female GPs also ordered laboratory tests for diagnostic or follow-up purposes more frequently (OR 1.21; 95% CI 1.03 to 1.43). Female GPs performed even more clinical examinations than male GPs to diagnose or follow-up injuries (OR 1.69; 95% CI 1.19 to 2.40).

CONCLUSION

Further research on the appropriateness of diagnostic procedures is required to determine to what extent these differences are related to underuse or overuse.

摘要

目的

女性医生人数的增加引发了人们对男女医生行医方式差异的关注。本研究旨在评估全科医生（GP）性别对三种主要诊断程序（临床检查、实验室检查和影像学检查）使用的影响。

设计

全国性的横断面多中心研究。

地点

法国培训全科诊所。

参与者

患者样本包括 2011 年 11 月至 2012 年 4 月期间每个诊所连续 5 天内所有自愿患者。GP 样本包括 85 名男性和 43 名女性。

方法

54 名全科实习医生观察他们的 GP 导师，收集 GP 和就诊的特征、就诊期间管理的健康问题以及与其相关的护理流程的数据。使用分层多水平混合效应逻辑回归模型，我们进行了多变量分析，以评估三种主要诊断程序中的每一种程序以及每种程序的两个特定多变量分析的差异，将筛查与诊断或随访程序区分开来。我们寻找了 GP 性别与患者性别或管理的健康问题类型之间的相互作用。

结果

对 20613 次就诊中管理的 45582 个健康问题进行的这项分析表明，女性 GP 进行的临床检查多于男性 GP，无论是筛查目的（OR 1.75；95%CI 1.19 至 2.58）还是诊断或随访目的（OR 1.41；95%CI 1.08 至 1.84）。女性 GP 也更频繁地为诊断或随访目的开具实验室检查（OR 1.21；95%CI 1.03 至 1.43）。女性 GP 甚至更频繁地为诊断或随访损伤进行临床检查（OR 1.69；95%CI 1.19 至 2.40）。