Kreuter M W, Strecher V J, Harris R, Kobrin S C, Skinner C S
Department of Community Health, School of Public Health, Saint Louis University, MO 63108, USA.
J Gen Intern Med. 1995 Mar;10(3):119-25. doi: 10.1007/BF02599664.
To determine the effects of physician gender on rates of Pap testing, mammography, and cholesterol testing when identifying and adjusting for demographic, psychosocial, and other patient variables known to influence screening rates.
A prospective design with baseline and six-month follow-up assessments of patients' screening status.
Twelve community-based group family practice medicine offices in North Carolina.
1,850 adult patients, aged 18-75 years (six-month response rate, 83%), each of whom identified one of 37 physicians as being his or her regular care provider.
Where screening was indicated at baseline, the patients of the women physicians were 47% more likely to get a Pap test [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.05, 2.04] and 56% more likely to get a cholesterol test (OR = 1.56, 95% CI = 1.08, 2.24) during the study period than were the patients of the men physicians. For mammography, the younger patients (aged 35-39 years) of the women physicians were screened at a much higher rate than were the younger patients of the men physicians (OR = 2.69, 95% CI = 0.98, 7.34); however, at older ages, the patients of the women and the men physicians had similar rates of screening.
In general, the patients of the women physicians were screened at a higher rate than were the patients of the men physicians, even after adjusting for important patient variables. These findings were not limited to gender-specific screening activities (e.g., Pap testing), as in some previous studies. However, the patients of the women physicians were aggressively screened for breast cancer at the youngest ages, where there is little evidence of benefit from mammography. Larger studies are needed to determine whether this pattern of effects reflects a broader phenomenon in primary care.
在识别并调整已知会影响筛查率的人口统计学、心理社会因素及其他患者变量时，确定医生性别对巴氏试验、乳房X线摄影及胆固醇检测率的影响。
一项前瞻性设计，对患者的筛查状况进行基线及六个月随访评估。
北卡罗来纳州的12个社区团体家庭医疗诊所。
1850名年龄在18至75岁之间的成年患者（六个月应答率为83%），每人指定37名医生中的一名作为其常规护理提供者。
在基线时表明需要进行筛查的情况下，在研究期间，女医生的患者进行巴氏试验的可能性比男医生的患者高47%[优势比（OR）=1.47，95%置信区间（CI）=1.05，2.04]，进行胆固醇检测的可能性高56%（OR = 1.56，95% CI = 1.08，2.24）。对于乳房X线摄影，女医生的年轻患者（35至39岁）的筛查率远高于男医生的年轻患者（OR = 2.69，95% CI = 0.98，7.34）；然而，在年龄较大时，女医生和男医生的患者筛查率相似。
总体而言，即使在调整了重要的患者变量后，女医生的患者筛查率仍高于男医生的患者。这些发现并不像之前一些研究那样仅限于特定性别的筛查活动（如巴氏试验）。然而，女医生的患者在最年轻的年龄段就被积极进行乳腺癌筛查，而在这个年龄段几乎没有证据表明乳房X线摄影有好处。需要进行更大规模的研究来确定这种效应模式是否反映了初级保健中的更广泛现象。
