Martin-Luther-University Halle Wittenberg, Medical Faculty, Institute of Nursing and Health Science, Magdeburger Str. 8, 06108, Halle (Saale) , Germany.
AOK Sachsen-Anhalt, Magdeburg, Germany.
BMC Health Serv Res. 2024 Mar 6;24(1):288. doi: 10.1186/s12913-024-10727-4.
Coronary heart diseases (CHDs) have experienced the largest increase worldwide as a cause of death, accounting for 16% of all deaths. In Saxony-Anhalt, a federal state in Germany, both CHD morbidity and acute myocardial infarction mortality rates are particularly high. Several risk factors associated with CHDs have been studied in Saxony-Anhalt, but sex differences in service use and medication have not been investigated. This study therefore aimed to investigate sex differences in the quality and quantity of cardiological care provided to adults with CHD.
This study used health claims data from 2018 to 2020 to analyse the utilisation of healthcare services and adherence to medication-related guideline recommendations in primary and specialist care. The sample included 133,661 individuals with CHD from a major statutory health insurance company (Germany).
Almost all CHD patients (> 99%) received continuous primary care. Continuous cardiologist utilisation was lower for females than for males, with 15.0% and 22.2%, respectively, and sporadic utilisation showed greater differences, with 33.5% of females and 43.4% of males seeking sporadic cardiologist consultations. Additionally, 43.1% of the identified CHD patients participated in disease management programmes (DMPs). The study also examined the impact of DMP participation and cardiologist care on medication uptake and revealed that sex differences in medication uptake, except for statin use, were mitigated by these factors. Statins were prescribed to 42.9% of the CHD patients eligible for statin prescription in accordance with the QiSA indicator for statin prescription eligibility. However, there were significant sex differences in statin utilisation. Female CHD patients were less likely to use statins (35.2%) than male CHD patients were (50.1%). The difference in statin utilisation persisted after adjustment for DMP participation and cardiologist consultation.
This study highlights sex differences in the utilisation of cardiological healthcare services for patients with CHD in the Saxony-Anhalt cohort. These findings underscore the continuing need for interventions to reduce sex inequalities in accessing healthcare and providing health care for patients with CHD. Factors at the health care system, patient, and physician levels should be further investigated to eventually improve statin prescription in people with CHD, especially women.
冠心病（CHD）已成为全球范围内导致死亡的首要原因，占所有死亡人数的 16%。在德国萨克森-安哈尔特州，CHD 的发病率和急性心肌梗死死亡率尤其高。该州已经研究了与 CHD 相关的多个风险因素，但尚未研究性别差异对服务利用和药物治疗的影响。因此，本研究旨在调查萨克森-安哈尔特州成年 CHD 患者的心血管护理质量和数量的性别差异。
本研究使用了 2018 年至 2020 年的健康索赔数据，分析了初级保健和专科保健中医疗服务的利用情况以及药物治疗相关指南建议的遵守情况。该样本包括一家主要法定健康保险公司（德国）的 133661 名 CHD 患者。
几乎所有 CHD 患者（>99%）都接受了连续的初级保健。女性连续接受心脏病专家治疗的比例低于男性，分别为 15.0%和 22.2%，而偶发性利用的差异更大，女性中有 33.5%，男性中有 43.4%寻求偶发性心脏病专家咨询。此外，43.1%的确定为 CHD 的患者参加了疾病管理计划（DMP）。本研究还检查了 DMP 参与和心脏病专家护理对药物使用的影响，结果表明，除他汀类药物使用外，这些因素减轻了药物使用方面的性别差异。根据他汀类药物使用资格的 QiSA 指标，符合他汀类药物使用资格的 CHD 患者中有 42.9%接受了他汀类药物治疗。然而，在他汀类药物使用方面存在显著的性别差异。女性 CHD 患者使用他汀类药物的比例（35.2%）低于男性（50.1%）。在调整了 DMP 参与和心脏病专家咨询后，他汀类药物使用的差异仍然存在。
本研究强调了萨克森-安哈尔特队列中 CHD 患者心血管医疗服务利用方面的性别差异。这些发现强调了需要继续采取干预措施，以减少获得医疗保健方面的性别不平等，并为 CHD 患者提供医疗保健。还应进一步研究医疗保健系统、患者和医生层面的因素，最终改善 CHD 患者，尤其是女性患者的他汀类药物处方。
