Gender differences in practice style: a Dutch study of general practitioners

An exploratory qualitative study exploring GPs' and psychiatrists' perceptions of post-traumatic stress disorder in postnatal women using a fictional case vignette

Postnatal post-traumatic stress disorder (PTSD) affects 3%-4% of women who give birth. It is underdiagnosed and undertreated. Thus far, no studies have investigated doctors' perceptions of PTSD in postnatal women. We investigated whether GPs and psychiatrists perceive PTSD symptoms after birth to indicate pathology and what diagnosis and management they would offer. Semi-structured interviews were conducted with six GPs and seven psychiatrists using a fictional vignette featuring a woman experiencing PTSD following a traumatic birth. A framework analysis approach was used. Despite half the GPs recognizing trauma-related features in the vignette their most common diagnosis was postnatal depression whereas six of the seven psychiatrists identified PTSD. Management plans reflected this. Both GPs and psychiatrists lacked trust in timeliness of referrals to psychological services. Both suggested referral to specialist perinatal mental health teams. Results suggest women are unlikely to get a PTSD diagnosis during initial GP consultations, however the woman-centred care proposed by GPs means that a trauma-focussed diagnosis later in the care pathway was not ruled out. Further research is needed to confirm these findings, which suggest that an evidence base around best management for women with postnatal PTSD is sorely needed, especially to inform GP training.

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

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.

Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study

BACKGROUND

The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario.

METHODS

We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients.

RESULTS

The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%-24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%-60% overall and by 10%-20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005-2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs.

INTERPRETATION

In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.

Gender matters in physiotherapy

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.

Significance of the physician's and the patient's sex in hospitalized patients with community-acquired pneumonia

BACKGROUND

Numerous studies have revealed that the sex of the patient or of the attending physician have impact on patient care, treatment, morbidity and mortality. Community-acquired pneumonia (CAP) is a common cause of hospitalization, antibiotic treatment and intensive care unit (ICU) admission. The purpose of this study was to examine if the patient's or the attending physicians' sex may influence the management of hospitalized patients with CAP.

METHODS

Our study included 826 consecutive inpatients with CAP (404 females, and 422 male patients, 429 patients initially treated by a female physician and 397 patients initially treated by a male physician). We examined if the patient's, or the initial attending physician's sex, affected treatment and outcome in patients with CAP.

RESULTS

Patients mean age was 69 years, 30-day mortality 9%. By use of the pneumonia severity index, male patients were found to be more severely ill at admission (p = .0008). Fewer female physicians' patients were admitted from the emergency department (ED) to the ICU when compared to male physicians' patients, 5% versus 10% (p = .006), and female physicians' patients received their first intravenous (IV) antibiotic dose later than male physicians' patients in the ED (p = .003).

CONCLUSION

Our study indicates that the sex of the attending physician may affect the chosen level of care and antibiotic treatment, and that admitted male patients with CAP were more seriously ill than admitted female patients with CAP.

Gender differences in the effect of medical humanities program on medical students' empathy: a prospective longitudinal study

BACKGROUND

Previous studies have suggested that Medical students' empathy declines during medical school, especially during the clinical studies. The aim of this study was to examine. Changes in medical students' empathy during their first clinical experience, and to determine the impact of gender and humanities curriculum on empathy changes.

METHODS

In this prospective longitudinal study, 262 4th year students from three consecutive classes were assessed. Empathy was assessed before and at 4th-year-end, using the Jefferson Scale of Physician Empathy-Student Version (JSPE-S). The three classes differed in humanities curriculum [limited Medical Humanities (MH_(lim)) vs. extended Medical Humanities (MH_(ext))], and in admission system [Personal Interview (PI) vs. multiple mini interviews (MMI)].

RESULTS

Overall, there was a small but significant decrease in JSPE-S during the fourth year (114.40 ± 11.32 vs. 112.75 ± 14.19, p = 0.034). Among men there was a statistically significant decline in JSPE-S during the fourth year, and the MH_(ext) (but not the MH_(lim)) was associated with the decline (t₍₃₅₎ = 2.38, p = 0.023). Women students showed no decline in empathy during the fourth-year of studies, regardless of type of humanities program. In addition, women who participated in MH_(ext) had a higher JSPE-S scores during the 4th -year as compared to women who participated in MH_(lim).

CONCLUSION

Pre-clinical humanities program was associated with a decline in empathy among men medical students during the fourth-year of medical studies. Gender differences in response to medical humanities programs require further study.

Patient preference for urologist gender

OBJECTIVES

To determine the factors associated with patients preferring the gender of their treating urologist in various clinical settings.

METHODS

A total of 400 urology outpatients participated in a structured interview on the nature of their presenting complaint, perception of their complaint and the preference for the gender of their urologist in four specific scenarios of consultation, physical examination, office-based procedure and surgery. Patients who expressed a gender preference received follow-up telephone calls.

RESULTS

A gender preference was expressed by 63 (15.8%), 108 (27.0%), 89 (22.3%) and 29 (7.3%) patients for the scenarios of consultation, physical examination, office-based procedure and surgery, respectively. Patients were more likely to have a preference if they were female or had a condition they considered embarrassing, with most preferences being for a gender-concordant urologist. Reasons included a previous negative experience and perceived gender-specific treatment styles. Patients who subsequently saw a doctor of the opposite gender to their preference were more likely to change their mind if their clinical interaction was positive.

CONCLUSIONS

Female patients, those with a perceived embarrassing condition and patients undergoing examination or office-based procedures are more likely to have a gender preference for their urologist, with a subsequent positive experience leading to patients discarding pre-existing preferences. With improved understanding of how patient characteristics, perception of their condition and previous experiences can affect their choices in various clinical situations, urologists can better meet patient expectations and address barriers to healthcare in urology.

Prescribing Behavior of General Practitioners for Generic Drugs

The factors influencing General Practitioners’ (GPs) prescribing behavior are diverse in terms of health care policies and regulations, GPs’ education and experience, demographic trends and disease profiles. Thus, it can be useful to analyze the specific local patterns, as they affect the quality of healthcare and the stability of the healthcare market. The aim of the present longitudinal retrospective study is to investigate the prescription of generic drugs in a database of about 4.6 million prescriptions from a sample of 38 GPs practicing in Salerno, Italy, within a timeframe of 15 years, from 2001 to 2015. The GPs in our study show a general tendency to increase prescriptions of generic drugs during the studied time span, to fulfill regulatory obligations and with some differences in prescription behavior according to age, gender and experience. The generics prescription depends also on the different diagnoses, with some diagnostic areas showing a greater generic drug prescription rate. Expanding this research to larger datasets would allow deepening the knowledge of the patterns of GPs’ prescribing decisions, to provide evidence to be used in comparison between different national settings.

The impact of general practitioners' gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

OBJECTIVES

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.

STUDY DESIGN

A nation-wide cross-sectional study was performed in 2016.

SETTING AND PARTICIPANTS

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.

MAIN OUTCOME MEASURES

Multilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.

RESULTS

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.

CONCLUSION

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.

Sex and Care: The Evolutionary Psychological Explanations for Sex Differences in Formal Care Occupations

Men and women exhibit clear differences in occupational choices. The present article elucidates sex differences in terms of formal care occupational choices and care styles based on evolutionary psychological perspectives. Broadly (1) the motivation to attain social status drives male preference for occupations that signals prestige and the desire to form interpersonal affiliation underlies female preference for occupations that involve psychosocial care for people in need; (2) ancestral sex roles leading to sexually differentiated cognitive and behavioral phenotypic profiles underlie present day sex differences in care styles where men are things-oriented, focusing on disease management while women are people-oriented, focusing on psychosocial management. The implications for healthcare and social care are discussed and recommendations for future studies are presented.

Are low and high utilization related to the way GPs manage their practices? An observational study

Background

General practice care plays a key role in keeping healthcare effective and cost-efficient. However, variation in the utilization rates of practices may reveal variation in practice performance. Our research goal is to investigate whether the socio-demographic profile of the patients’ area of residence and practice organization characteristics influence the low or high utilization of general practice care.

Methods

Data on the utilization of general practice care were derived from the electronic health records of 232 general practices participating in the NIVEL Primary Care Database for the year 2013. Census data for the year 2013 were matched with the postal code of the patients. A small area estimation (SAE) technique was used to calculate the estimated utilization rate for general practice care per practice based on the socio-demographic profile of the patients’ area of residence. Subsequently, the actual utilization rates were compared to the estimated rates per practice. Linear regression analysis was used to link the differences between the actual and estimated utilization rates to practice organization characteristics.

Results

The socio-demographic profile of the patients’ area of residence accounted for 25.7% of the estimated utilization rates per practice. Practice organization characteristics accounted for 19.3% of the difference between the actual utilization rates and the estimated rates. Practices had higher utilization rates than estimated when a practice was a dual practice, when it employed female GPs, when it employed other healthcare providers and/or when it offered more services related to a disease management programme.

Conclusion

We found that utilization rates of general practice care can be partially explained by the socio-demographic profile of the patients’ area of residence, but also by practice organization characteristics. Insight into these factors provides both GPs and the other stakeholders involved in the organization of general practice care with information to help reflect on the utilization of care.

Changes in the Practice Patterns and Demographics of Ontario Dermatologists

Background:

Changes in the practice patterns and demographics of Canadian dermatologists remain largely unknown and would be helpful in assessing the future practice of dermatology across Canada.

Objective:

To assess changes in the population of Ontario dermatologists over time and the factors that influence their practice patterns, caseload, and the procedures they perform.

Methods:

A retrospective population-based analysis was performed using comprehensive administrative data on Ontario Health Insurance Plan insured dermatology visits and procedures from April 1, 2009, to March 31, 2015.

Results:

The number of dermatologists practicing in Ontario per 100 000 people increased from 1.52 (2009) to 1.62 (2014). During this period, the proportion of female dermatologists increased from 40% to 47%, and the proportion of male dermatologists decreased from 60% to 53%. The mean number of patient visits per dermatologist decreased from 6323 (2009) to 5877 (2014). Females saw a decrease from 4818 to 4181 visits, and males remained constant at 7274 to 7265 visits. Middle career dermatologists had more patient visits compared to those in their early or late career. A rural practice was associated with more patient visits compared to an urban one. The proportion of dermatologists providing nonemergency in-hospital patient services declined. The number of biopsies and malignant excisions performed increased.

Conclusions:

The number of dermatologists at the population level increased and the number of patient visits per dermatologist decreased. Career stage, physician sex, and practice location all affect the practice of dermatology. Future studies to assess underlying factors for these observations would be of value.

Disengagement of general practitioners in cervical cancer screening

In the absence of organized cervical cancer screening (CCS) programs, gynecologists remain principal actors in obtaining a Pap smear, followed by general practitioners (GPs). In France, with the growing scarcity of gynecologists and social inequalities in access to opportunistic screening, GPs are valuable resources for women's gynecologic follow-up. We aimed to investigate the characteristics of GPs who do not perform CCS, analyzing the effect of GPs' sex and their evolution over time. On the basis of data from three cross-sectional surveys conducted among representative samples of French GPs in 1998, 2002, and 2009 (n=5199), we constructed univariate and multivariate logistic mixed models (level 2: county, level 1: GP) with random intercept stratified on GPs' sex to investigate the characteristics of the GPs associated with no practice of CCS ever. Almost one-third of all GPs did not perform CCS ever and it increased with time. Male GPs were always more likely not to perform it (odds ratio=0.50, 95% confidence interval=0.42-0.59). The percentage of GPs not performing CCS increased more markedly among male than among female GPs, and increased more among the youngest age group. Increasingly fewer GPs engage in CCS when the growing scarcity of medical gynecologists calls for more participation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differently according to the practitioner's sex.

Physician and practice characteristics associated with immunoglobulin test ordering

BACKGROUND

Primary care test requests for serum immunoglobulins are rising rapidly, with concerns that many requests may be unnecessary. Evidence suggests some characteristics of general practitioners (GPs) and practices are associated with higher test ordering.

OBJECTIVE

To identify the physician and practice characteristics associated with immunoglobulin test ordering.

METHODS

Retrospective, cross-sectional study using routine laboratory data on primary care serum immunoglobulin requests. Data were linked with GP patient list size data. The primary outcome measure was the count of test requests per GP. Predictor variables were physician gender, years experience, practice region and type (number of GPs), GP patient list size and composition. Mixed-effects multilevel regression models were used to calculate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for the associations between physician and practice characteristics and GP requesting. Sensitivity analysis was performed by limiting the model to the more than 70 years age category.

RESULTS

In total, 5990 immunoglobulin tests were ordered by 481 GPs in the South of Ireland during 2013. The number of tests ordered by individual GPs varied from one to 377. In the final fully adjusted Poisson regression analysis, female gender (IRR: 1.81; 95% CI: 1.45-2.26) and less experience (IRR: 2.27; 95% CI: 1.47-3.51) were associated with higher requesting (P < 0.001). None of the practice factors were associated with test ordering. Sensitivity analysis on the 70 years or more age category found similar results.

CONCLUSION

Further research is required to explore the potential reasons for higher requesting among GPs with fewer years of experience and also among female GPs.

Patterns and predictors of physician adoption of new cardiovascular drugs

BACKGROUND

Little is known about physicians' approaches to adopting new cardiovascular drugs and how adoption varies between drugs of differing novelty.

METHODS

Using data on dispensed prescriptions from IMS Health's Xponent™ database, we created a cohort of all primary care physicians (PCPs) and cardiologists in Pennsylvania who regularly prescribed anticoagulants, antihypertensives and statins from 2007 to 2011. We examined prescribing of three new cardiovascular drugs of differing novelty: dabigatran, aliskiren and pitavastatin. Outcomes were rapid adoption of each new drug, defined by early and sustained monthly prescribing detected by group-based trajectory models, by physicians within the first 15 months of marketplace introduction.

RESULTS

5953 physicians regularly prescribed each drug class. The majority of physicians (63.8%) adopted zero new drugs in the first 15 months, 35.0% rapidly adopted one or two, and 1.2% rapidly adopted all three. Physicians were more likely to rapidly adopt the most novel drug, dabigatran (27.3%), than aliskiren (10.5%) or pitavastatin (8.0%). Physician specialty and sex were the most consistent predictors of adoption. Compared to PCPs, cardiologists were more likely to rapidly adopt dabigatran (Adjusted Odds Ratio 8.90, 95% confidence interval 7.42-10.67; P<0.001) aliskerin (2.05, CI 1.56-2.69; P<0.001) and pitavastatin (3.44, CI 2.60-4.57; P<0.001). Female physicians were less likely to adopt dabigatran (0.71, CI 0.59-0.85; P <0.001) and aliskiren (0.64, CI 0.49-0.83; P <0.001).

CONCLUSIONS

Physicians vary in their prescribing of recently-introduced cardiovascular drugs. Though most physicians did not rapidly adopt any new cardiovascular drugs, drug novelty and cardiology training were associated with greater adoption.

Gender differences in French GPs' activity: the contribution of quantile regressions

In any fee-for-service system, doctors may be encouraged to increase the number of services (private activity) they provide to receive a higher income. Studying private activity determinants helps to predict doctors' provision of care. In the context of strong feminization and heterogeneity in general practitioners' (GP) behavior, we first aim to measure the effects of the determinants of private activity. Second, we study the evolution of these effects along the private activity distribution. Third, we examine the differences between male and female GPs. From an exhaustive database of French GPs working in private practice in 2008, we performed an ordinary least squares (OLS) regression and quantile regressions (QR) on the GPs' private activity. Among other determinants, we examined the trade-offs within the GPs' household considering his/her marital status, spousal income, and children. While the OLS results showed that female GPs had less private activity than male GPs (-13%), the QR results emphasized a private activity gender gap that increased significantly in the upper tail of the distribution. We also find gender differences in the private activity determinants, including family structure, practice characteristics, and case-mix variables. For instance, having a youngest child under 12 years old had a positive effect on the level of private activity for male GPs and a negative effect for female GPs. The results allow us to understand to what extent the supply of care differs between male and female GPs. In the context of strong feminization, this is essential to consider for organizing and forecasting the GPs' supply of care.

How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study

BACKGROUND

Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners' (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription.

METHODS

This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs' age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis.

RESULTS

The high prescribers were middle-aged (40-59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs' workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population.

CONCLUSIONS

Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP's practice.

Do male and female general practitioners differently prescribe chronic pain drugs to older patients?

OBJECTIVE

The aim of this study was to identify the relationship between general practitioner (GP) gender and prescribing practice of chronic pain drugs in older adults.

DESIGN

Cross-sectional observational study.

SETTING

GPs in private practice throughout France.

SUBJECTS

Two hundred and sixty GPs (80.8% male and 19.2% female) enrolled 1,379 (28.4% male and 71.6% female) noninstitutionalized patients over 65 years of age, suffering from chronic pain.

METHODS

A comparison of prescribing habits between male and female GPs was performed on baseline data with univariate analyses followed by multivariate analyses after taking several confounding factors into account.

RESULTS

No significant differences were found when comparing male and female GPs' prescriptions of World Health Organization step 1, step 2, and step 3 analgesics. Male GPs were more likely than female GPs to prescribe antineuropathic pain drugs (11.3% of patients with male GPs versus 4.8% of patients with female GPs, P = 0.004) and less likely to prescribe symptomatic slow-acting drugs for osteoarthritis (SySADOA) (10.2% of male GPs' patients versus 18.8% of female GPs' patients, P = 0.0003). After adjusting for several confounding factors, male GPs were still more likely to prescribe antineuropathic pain drugs (OR 2.43, 95% CI 1.15-5.14, P = 0.02) and less likely to prescribe symptomatic slow-acting drugs (OR 0.64, 95% CI 0.42-0.97, P = 0.03).

CONCLUSION

Male and female GPs prescribe analgesics in a similar manner. However, male GPs prescribe more antineuropathic pain drugs, but fewer SySADOA.

Factors affecting the uptake of new medicines: a systematic literature review

BACKGROUND

The successful diffusion of new drugs is crucial for both pharmaceutical companies and patients-and of wider stakeholder concern, including for the funding of healthcare provision. Micro-level characteristics (the socio-demographic and professional characteristics of medical professionals), meso-level characteristics (the prescribing characteristics of doctors, the marketing efforts of pharmaceutical companies, interpersonal communication among doctors, drug attributes, and the characteristics of patients), and macro-level characteristics (government policies) all influence the diffusion of new drugs. This systematic literature review examines the micro- and meso-level characteristics of early prescribers of newly introduced drugs. Understanding the characteristics of early adopters may help to speed up the diffusion process, promote cost-efficient prescribing habits, forecast utilisation, and develop targeted intervention strategies.

METHODS

The PubMed and Scopus electronic databases were chosen for their extensive coverage of the pertinent literature and used to identify 205 potentially relevant studies by means of a four-layered search string. The 35 studies deemed eligible were then synthetized carefully and critically, to extract variables relevant to this review.

RESULTS

Early adoption of new drugs is not a personal trait, independent of drug type, but early adopters share both micro- and meso-level characteristics. At prescriber level, doctors' interest in particular therapeutic areas, participation in clinical trials, and volume of prescribing-either in total or within the therapeutic class of the new drug-increase the likelihood of early adoption. The marketing efforts of pharmaceutical companies and doctors' professional and social interactions leading to prescribing contagion are very powerful predictors of new drug uptake. At patient level, doctors with younger patients, patients with higher socioeconomic statuses and/or patients with poorer health statuses are more inclined to prescribe new drugs early. In contrast, the socio-demographic characteristics of prescribers and many practice-related factors play little role in the adoption process.

CONCLUSIONS

The most powerful predictors of new drug uptake include the doctors' strong scientific commitment, high prescribing volume in total or in within the therapeutic class of the new drug, high exposure to marketing, and intense communication with colleagues.

Talking about depression: an analogue study of physician gender and communication style on patient disclosures

OBJECTIVES

To disentangle the effects of physician gender and patient-centered communication style on patients' oral engagement in depression care.

METHODS

Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS).

RESULTS

Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p<.05). APs were more willing to continue treatment with gender-discordant HPC physicians (p<.05). No effects were evident in the LPC condition.

CONCLUSIONS

Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender.

PRACTICE IMPLICATIONS

High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.

Selective prevention of cardiometabolic diseases in general practice: attitudes and working methods of male and female general practitioners before and after the introduction of the Prevention Consultation guideline in the Netherlands

RATIONALE, AIMS AND OBJECTIVES

In 2011 the module cardiometabolic risk of the Prevention Consultation guideline was introduced in the Netherlands in order to prevent cardiometabolic diseases. We aimed to compare attitudes and working methods of Dutch general practitioners (GPs) towards selective prevention of cardiometabolic diseases before and after the introduction of the guideline and to study the effect of GP gender on these attitudes and working methods.

METHODS

We compared attitudes and working methods in prevention of cardiometabolic diseases in a cross-sectional survey among Dutch GPs in 2013 to the results of a comparable study performed in 2008.

RESULTS

Both in 2008 and 2013 30% responded. In 2013, more GPs reported to actively invite patients for preventive measurements. Thirty per cent of the GPs implemented the module cardiometabolic risk. In 2013, less GPs reported that it is worthwhile to make an effort to detect patients at increased risk for cardiometabolic diseases, and more GPs suggested that prevention may be performed by other stakeholders compared with 2008. Financial support and evidence for prevention programmes were mentioned as main facilitators for prevention. In 2013, more male than female GPs actively invite patients for preventive measurements.

CONCLUSIONS

More GPs report active preventive working methods after the introduction of the Prevention Consultation guideline, but only 30% implemented the guideline. More male than female GPs actively invite patients for preventive measurements. Compared with 2008 less GPs think it is worthwhile to make an effort to detect patients at increased risk and more GPs are willing to delegate preventive actions to other health institutions in 2013. As financial support and evidence for prevention are important facilitators for prevention, further research of the effectiveness of the guideline in preventing cardiometabolic diseases is necessary, and political choices have to be made in order to financially facilitate selective prevention in general practice.

The implications of the feminization of the primary care physician workforce on service supply: a systematic review

There is a widespread perception that the increasing proportion of female physicians in most developed countries is contributing to a primary care service shortage because females work less and provide less patient care compared with their male counterparts. There has, however, been no comprehensive investigation of the effects of primary care physician (PCP) workforce feminization on service supply. We undertook a systematic review to examine the current evidence that quantifies the effect of feminization on time spent working, intensity and scope of work, and practice characteristics. We searched Medline, Embase, and Web of Science from 1991 to 2013 using variations of the terms 'primary care', 'women', 'manpower', and 'supply and distribution'; screened the abstracts of all articles; and entered those meeting our inclusion criteria into a data abstraction tool. Original research comparing male to female PCPs on measures of years of practice, time spent working, intensity of work, scope of work, or practice characteristics was included. We screened 1,271 unique abstracts and selected 74 studies for full-text review. Of these, 34 met the inclusion criteria. Years of practice, hours of work, intensity of work, scope of work, and practice characteristics featured in 12%, 53%, 42%, 50%, and 21% of studies respectively. Female PCPs self-report fewer hours of work than male PCPs, have fewer patient encounters, and deliver fewer services, but spend longer with their patients during a contact and deal with more separate presenting problems in one visit. They write fewer prescriptions but refer to diagnostic services and specialist physicians more often. The studies included in this review suggest that the feminization of the workforce is likely to have a small negative impact on the availability of primary health care services, and that the drivers of observed differences between male and female PCPs are complex and nuanced. The true scale of the impact of these findings on future effective physician supply is difficult to determine with currently available evidence, given that few studies looked at trends over time, and results from those that did are inconsistent. Additional research examining gender differences in practice patterns and scope of work is warranted.

Access to rheumatologists among patients with newly diagnosed rheumatoid arthritis in a Canadian universal public healthcare system

OBJECTIVES

Our objective was to estimate the percentage of patients with incident rheumatoid arthritis (RA) who were seen by a rheumatologist within 3, 6 and 12 months of suspected diagnosis by a family physician, and assess what factors may influence the time frame with which patients are seen.

SETTING

Ontario, Canada.

PARTICIPANTS

Over 2000-2009, we studied patients with incident RA who were initially diagnosed by a family physician.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed secular trends in rheumatology encounters and differences between patients who received versus did not receive rheumatology care. We performed hierarchical logistic regression analyses to determine whether receipt of rheumatology care was associated with patient, primary care physician and geographical factors.

RESULTS

Among 19 760 patients with incident RA, 59%, 75% and 84% of patients were seen by a rheumatologist within 3, 6 and 12 months, respectively. The prevalence of initial consultations within 3 months did not increase over time; however, access within 6 and 12 months increased over time. Factors positively associated with timely consultations included higher regional rheumatology supply (adjusted OR (aOR) 1.35 (95% CI 1.13 to 1.60)) and higher patient socioeconomic status (aOR 1.18 (95% CI 1.07 to 1.30)). Conversely, factors inversely associated with timely consultations included remote patient residence (aOR 0.51 (95% CI 0.41 to 0.64)) and male family physicians (aOR 0.88 (95% CI 0.81 to 0.95)).

CONCLUSIONS

Increasing access to rheumatologists within 6 and 12 months occurred over time; however, consultations within 3 months did not change over time. Measures of poor access (such as proximity to and density of rheumatologists) were negatively associated with timely consultations. Additional factors that contributed to disparities in access included patient socioeconomic status and physician sex.

Gender differences in health-related quality of life of Australian chronically-ill adults: patient and physician characteristics do matter

BACKGROUND

The aims of this study were to explore the health-related quality of life (HRQoL) in a large sample of Australian chronically-ill patients (type 2 diabetes and/or hypertension/ischaemic heart disease), to investigate the impact of characteristics of patients and their general practitioners on their HRQoL and to examine clinically significant differences in HRQoL among males and females.

METHODS

This was a cross-sectional study with 193 general practitioners and 2181 of their chronically-ill patients aged 18 years or more using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) were derived using the standard US algorithm. Multilevel regression analysis (patients at level 1 and general practitioners at level 2) was applied to relate PCS-12 and MCS-12 to patient and general practitioner (GP) characteristics.

RESULTS

Employment was likely to have a clinically significant larger positive effect on HRQoL of males (regression coefficient (B) (PCS-12) = 7.29, P < 0.001, effect size = 1.23 and B (MCS-12) = 3.40, P < 0.01, effect size = 0.55) than that of females (B(PCS-12) = 4.05, P < 0.001, effect size = 0.78 and B (MCS-12) = 1.16, P > 0.05, effect size = 0.16). There was a clinically significant difference in HRQoL among age groups. Younger men (< 39 years) were likely to have better physical health than older men (> 59 years, B = -5.82, P < 0.05, effect size = 0.66); older women tended to have better mental health (B = 5.62, P < 0.001, effect size = 0.77) than younger women. Chronically-ill women smokers reported clinically significant (B = -3.99, P < 0.001, effect size = 0.66) poorer mental health than women who were non-smokers. Female GPs were more likely to examine female patients than male patients (33% vs. 15%, P < 0.001) and female patients attending female GPs reported better physical health (B = 1.59, P < 0.05, effect size = 0.30).

CONCLUSIONS

Some of the associations between patient characteristics and SF-12 physical and/or mental component scores were different for men and women. This finding underlines the importance of considering these factors in the management of chronically-ill patients in general practice. The results suggest that chronically ill women attempting to quit smoking may need more psychological support. More quantitative studies are needed to determine the association between GP gender and patient gender in relation to HRQoL.

Role of physician gender in drug therapy

There is evidence that female patients receive less intensified drug therapy in many medical conditions than male patients. However, there are only limited data regarding the influence of physician gender on drug therapy. It has been shown, for example, that female physicians tend to adhere more closely to guideline-recommended pharmacotherapy compared to their male counterparts. In some medical conditions where drug therapy is only one among various components of a complex interplay of therapeutic regimes (e.g., diabetes, cardiovascular diseases, depression, pain management), female physicians seem to achieve better overall intermediate outcomes and some studies suggest that "better" drug therapy is provided by female compared to male physicians. The reasons for the overall better outcomes may be superior communication skills of female physicians, participatory decision making, and consequently improved drug adherence in addition to or in combination with more effective non-pharmacologic treatment results. It is impossible to distinguish between the individual contributions of drug- and nondrug-related influence on such improved outcomes and thus to determine whether they are due to unconfounded physician gender effects on drug therapy. There is until now in no area of medicine evidence to suggest that a patient will consistently receive higher quality of drug therapy by switching to a physician of a specific gender.

How patients choose osteopaths: a mixed methods study

OBJECTIVES

To explore how patients choose individual osteopaths to consult; to test whether patients' preferences for osteopaths depend on gender, the osteopath's qualifications, and the cost of treatment; to explore patients' perspectives.

DESIGN

An explanatory mixed methods design incorporating a quasi-experimental study administered by postal survey and a qualitative interview study.

SETTING

One sample of patients at a private-sector complementary therapy clinic in the UK completed a survey; a second sample of patients recruited from osteopathy clinics took part in qualitative interviews.

MAIN OUTCOME MEASURES

In the survey, male and female respondents (n=176) rated the likelihood of consulting each of 8 fictional osteopaths, representing all possible combinations of 3 factors (practitioner gender, biomedically qualified or not, working in a public sector or private clinic). Semi-structured qualitative interviews (n=19) about patients' experiences of osteopathy were analysed deductively and inductively.

RESULTS

Survey respondents preferred osteopaths who were also biomedical doctors, F(1,174)=67.21, p<0.001, η(2)=0.28. Qualitative data showed that, when choosing an osteopath, patients valued personal recommendations from a trusted source and such recommendations overrode other considerations. First impressions were important and were based on patients' perceptions of an osteopath's competence, interpersonal fit, and immediate treatment effect.

CONCLUSIONS

Word of mouth appears to be the primary mechanism by which patients choose individual osteopaths; in the absence of personal recommendations, some patients prefer biomedically qualified practitioners. Trustworthy and appropriate information about practitioners (e.g. from professional regulatory bodies) could empower patients to make confident choices when seeking individual complementary practitioners to consult.

Efficacy of influenza vaccine among elderly patients by physical activity status

OBJECTIVE

Although many studies have shown the usefulness of influenza vaccine in elderly in-patients, the efficacy of vaccination with regard to the daily physical activities of patients has not been fully evaluated. To address this issue, we correlated the use of medical resources with vaccination status in patients categorized according to their daily activity levels.

METHODS

The subjects comprised 237 in-patients at or above 51 years of age, who were hospitalized in the long-term care unit of a Japanese hospital between January and March, 1999. The vaccination status and medical resources use (i.e., oral antibiotics, injected antibiotics, blood cell count, chest X-ray) of each patient were recorded, and the patients were assigned to three subgroups, based on daily life activity scores.

RESULTS

Vaccinated in-patients in the 'bed-bound' category required fewer medical resources, i.e., oral antibiotics (-2.29 days,P<0.05), injected antibiotics (-5.02 days,P<0.001), blood cell counts (-4.66 times,P<0.001), and chest X-rays (-4.31 times,P<0.001), compared with unvaccinated in-patients. There were no significant differences in treatment parameters between vaccinated and unvaccinated patients in the 'partly limited' or 'no limitation' categories.

CONCLUSIONS

It is suggested that influenza vaccination significantly reduces the need for medical treatment only among those in-patients who are the least physically active. Further studies are required to replicate these findings, and to elucidate the underlying reasons for this reduction.

Variation in HbA1c prescription for patients with diabetes in French general practice: an observational study prior to the implementation of a P4P programme

BACKGROUND

Prior to a large diffusion of a pay-for-performance programme (P4P) in primary care in France, it seemed of particular interest to identify, the doctors not performing optimally who could be the main target of this programme. Based on the example of HbA1c prescription for patients with diabetes, this study examined the impact of general practitioner's (GPs) characteristics on the variation of a P4P indicator for diabetes care, i.e. the percentage of patients undergoing three or four HbA1c tests during one year.

METHODS

We used a large database from the national health insurance fund for salaried workers in Brittany to select a cohort of patients with diabetes who had been attended to by their doctors for 1 year. In all, 2545 GPs attending to 41,453 patients with diabetes were included. A two-level hierarchical logistic model was used to analyse the data.

RESULTS

Thirty-six per cent (SD = 22.3) of patients with diabetes underwent three or four HbA1c tests during the year (the target objective was 65% in a patient list). There was a large variability between GPs, even after adjusting for patient characteristics. Doctors who were female, young, working in a group practice, participating in quality-control groups, and who had a lower patient load prescribed the three or four recommended tests more often.

DISCUSSION

The results indicate a target group of doctors which require attention. There is still room to improve the quality of care for patients with diabetes in general practice, notably by encouraging doctors to train better and practice in groups.

How patients choose acupuncturists: a mixed-methods project

OBJECTIVES

Patients can have difficulties choosing acupuncturists in the United Kingdom because acupuncturists are not all subject to statutory regulation. Research has identified factors that influence patients' choice of general practitioner. However, how patients choose acupuncturists has not been studied. The aim was to investigate how patients choose acupuncturists and to identify which factors might influence this choice.

DESIGN

A mixed-methods design used an exploratory qualitative study followed by a quantitative study. The qualitative study explored patients' experiences of acupuncture. The quantitative vignette study investigated the impact of patient gender and practitioner factors (gender, training location, and qualifications) on choice of acupuncturist.

METHODS

In the qualitative study, 35 acupuncture patients (recruited through maximum variation sampling from seven clinics and the community) participated in semistructured interviews about their acupuncture experiences. In the quantitative study, 73 participants imagined wanting to consult an acupuncturist for back pain. They rated 8 fictional acupuncturists; ratings were analyzed using analysis of covariance.

RESULTS

Patients wanted qualified, personable acupuncturists and valued recommendations from trusted others. Without such recommendations, potential patients preferred female acupuncturists (F(1,69)=4.504, p<0.05) and those with medical qualifications (F(1,69)=44.832, p<0.01).

CONCLUSIONS

The decision to consult a particular acupuncturist is not straightforward. Acupuncturists' trustworthiness and technical competence are important to (potential) patients; practitioner gender also influenced preferences. Patients need to be informed about proposals concerning statutory regulation in CAM and its implications; conventional practitioners might be able to better support their patients wanting to consult acupuncturists.

The role of expectations in preferences of patients for a female or male general practitioner

OBJECTIVE

to determine, for five health problems, whether preference for a male or female general practitioner (GP) is related to patient gender, GP gender and/or patient expectations of GP behaviour.

METHODS

cross-sectional study in 14 health centres in Spain, administering a questionnaire to 360 patients. Outcome variables were: preference for male GP, female GP or no preference in consultations for five hypothetical health problems.

RESULTS

mean age was 47.3 ± 16.5 years, 51% were female. Preference was more frequently expressed by females. Odds ratios (ORs) for a woman preferring a female to male GP ranged from 3 to 508, according to the hypothetical problem, and ORs for a patient with female GP preferring a female GP ranged from 2.8 to 9.1. Patient gender and GP gender had no interactive effect on preferences. Expectations of GP behaviour were related to preferences, except for chest pain. Higher expectations of communication or technical care were associated with greater preference for female or male GP, respectively.

CONCLUSIONS

patient gender and current GP gender are related to preferences in five hypothetical clinical situations and expectations of GP behaviour to preferences in four of them.

PRACTICE IMPLICATIONS

educational strategies are needed to adjust clinical encounters to patients' preferences.

Are health care professionals able to judge cancer patients' health care preferences correctly? A cross-sectional study

Background

Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values.

The aim of this study was to explore to what extent there is concordance between patients' preferences in cancer care and patients' preferences as estimated by health care professionals. We also examined whether there were gender differences between health care professionals with regard to the degree in which they can estimate patients' preferences correctly.

Methods

To obtain unbiased insight into the specific preferences of cancer patients, we developed the 'Cancer patients' health care preferences' questionnaire'. With this questionnaire we assessed a large sample of cancer patients (n = 386). Next, we asked health care professionals (medical oncologists, nurses and policymakers, n = 60) to fill out this questionnaire and to indicate preferences they thought cancer patients would have. Mean scores between groups were compared using Mann-Whitney tests. Effect sizes (ESs) were calculated for statistically significant differences.

Results

We found significant differences (ESs 0.31 to 0.90) between patients and professionals for eight out of twenty-one scales and two out of eight single items. Patients valued care aspects related to expertise and attitude of health care providers and accessibility of services as more important than the professionals thought they would do. Health care professionals overestimated the value that patients set on particularly organisational and environmental aspects.

We found significant gender-related differences between the professionals (ESs 0.69 to 1.39 ) for eight out of twenty-one scales and two out of eight single items. When there were significant differences between male and female healthcare professionals in their estimation of patients health care preferences, female health care professionals invariably had higher scores. Generally, female health care professionals did not estimate patients' preferences and needs better than their male colleagues.

Conclusions

Health care professionals are reasonably well able to make a correct estimation of patients preferences, but they should be aware of their own bias and use additional resources to gain a better understanding of patients' specific preferences for each patient is different and ultimately the care needs and preferences will also be unique to the person.

Do regional primary-care organisations influence primary-care performance? A dynamic panel estimation

The role of regional primary-care organizations (PCOs) in health-care systems is not well understood. This is the first study to attempt to isolate the effect of regional PCOs on primary-care performance. We examine Divisions of General Practice in Australia, which were established in 1992. A unique Division-level panel data set is used to examine the effect of Divisions, and their activities, on various aspects of primary-care performance. Dynamic panel estimation is used to account for state dependence and the endogeneity of Divisions' activities. The results show that Divisions were more likely to have influenced general practice infrastructure than clinical performance in diabetes, asthma and cervical screening. The effect of specific Division activities, such as providing support for practice nurses and IT support, was not directly related to changes in the level of general practice performance. Specific support in the areas of diabetes and asthma was associated with general practice performance, but this was due to reverse causality and the effect of unobservable factors, rather than the direct effect of Divisions.

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice

This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

Nonverbal sensitivity in medical students: implications for clinical interactions

BACKGROUND

Clinicians' accuracy in perceiving nonverbal cues has potentially important consequences, but has received insufficient research.

OBJECTIVE

To examine the relation of medical students' nonverbal sensitivity to their gender and personal traits, as well as to their communication and impressions made during a standardized patient (SP) visit.

DESIGN

Psychometric testing, questionnaire, and observation.

SETTING

One US medical school.

PARTICIPANTS

Two-hundred seventy-five third-year medical students.

MEASUREMENTS

Nonverbal sensitivity and attitudes were measured using standard instruments. Communication during the SP visit was measured using trained coders and analogue patients who viewed the videotapes and rated the favorability of their impressions of the student.

RESULTS

Nonverbal sensitivity was higher in female than male students (P < 0.001) and was positively correlated with self-reported patient-centered attitudes (P < 0.01) and ability to name one's own emotions (P < 0.05). It was also associated with less distressed (P < 0.05), more dominant (P < 0.001), and more engaged (P < 0.01) behavior by the SP, and with more liking of the medical student (P < 0.05) and higher ratings of compassion (P < 0.05) by the analogue patients. Correlations between nonverbal sensitivity and other variables were generally stronger and different for male than female students, but nonverbal sensitivity predicted analogue patients' impressions similarly for male and female students.

CONCLUSION

Medical students' nonverbal sensitivity was related to clinically relevant attitudes and behavioral style in a clinical simulation.

A survey of Dutch GPs' attitudes towards help seeking and follow-up care for relatives bereaved by suicide

BACKGROUND

Relatives who are bereaved by suicide likely consult their GP when they feel the need for professional help. GPs may play a key role in establishing who is at risk for adverse consequences of the loss as they are familiar with relatives' possible psychiatric vulnerabilities. The availability of evidence-based services for relatives of suicide victims is limited. Successful implementation of services needs analysis of key factors considered critical in the achievement of changes. We investigated GPs' management of help requests of relatives bereaved by suicide and examined determinants of GPs willingness to refer for evidence-based follow-up care.

METHODS

A cross-sectional survey among 488 GPs in the northern part of The Netherlands.

RESULTS

A 44% response was achieved (n = 214) during the last 3 years, 38 (18%) were exposed to suicide, 21 (10%) to help requests without being exposed to suicide and 52 (24%) to both suicide and help requests. Out of 106 requests, 69 (65%) were handled by the GP; 60 (57%) were either directly or additionally referred, principally for mental health care. Suicide exposure and female gender were associated with the doctor's perception that follow-up care following a loss through suicide is useful. The perception that help is useful increased the likelihood of GPs' referral for evidence-based follow-up care.

CONCLUSIONS

GPs support the availability of evidence-based follow-up care for relatives of suicide victims. To modify GPs' key role in referring relatives for it, GPs should be well informed of its usefulness and to whom.

Family physicians' personal and practice characteristics that are associated with improved utilization of bone mineral density testing and osteoporosis medication prescribing

Family physicians' personal and practice characteristics may influence how osteoporosis is managed. Thus, we evaluated the impact of family physicians' personal and practice characteristics on the appropriate use of bone mineral density testing and osteoporosis therapy. The physician questionnaire assessed 13 personal and practice characteristics of the physicians. The patient questionnaire was used to collect data to ascertain how family physicians managed osteoporosis. A total of 225 family physicians from 7 provinces across Canada completed both the physician and patient questionnaires. The family physicians evaluated a total of 5601 patients. The generalized estimating equations technique was utilized to model the associations between family physicians' personal and practice characteristics and appropriate use of bone mineral density testing and osteoporosis therapy. Odds ratios (OR) and corresponding 95% confidence intervals (CI) are reported. Findings indicated that female family physicians have higher odds of administering appropriate bone density testing compared to male family physicians (OR: 1.28; 95% CI: 1.05, 1.55), and that physicians who have hospital privileges (OR: 0.77; 95% CI: 0.62, 0.97) and who graduated more recently from medical school (OR: 0.87; 95% CI: 0.77, 0.99) have lower odds of administering appropriate bone mineral density tests. Physicians who use electronic health records have higher odds of administering appropriate therapy (OR: 1.30; 95% CI: 1.06, 1.59) as compared to physicians who do not use them. Several family physicians' personal and practice characteristics are associated with appropriate utilization of bone mineral density testing and therapy. The education of both clinicians and policy makers regarding these new insights may translate to enhanced individual practices and an improved overall health care system to optimize the environment for managing osteoporosis.

Simply because it works better: exploring motives for the use of medical herbalism in contemporary U.K. health care

AIM

To clarify the reasons underlying people's use of medical herbalism in the context of contemporary U.K. health care.

DESIGN

This qualitative, interpretative study recruited 19 adults who were consulting with registered medical herbalists in a region of southern England. Participants were interviewed about their experiences and the data were analysed thematically. Study methodology was informed by Gadamerian hermeneutic phenomenology.

RESULTS

Few of the participants had initially set out to try herbalism, most looking for 'an alternative' to conventional health care. The main reason for exploring non-conventional options was to seek out health care that would more effectively meet their self-perceived needs in the treatment of a chronic condition. As a result of favourable outcomes from their initial treatment, participants subsequently continued to use herbalism for the management of more general, everyday health problems.

CONCLUSIONS

Lay and professional ideas about what constitutes health care 'effectiveness' do not necessarily correspond. Participants reported that, in comparison to conventional medicine, medical herbalism satisfied their expectations of health care because it more readily met their own criteria for effectiveness and because it had greater consistency with their own understanding about health, illness and health care. Central to achieving this was the collaborative nature of the herbalist's approach, as well as the therapeutic effect and enduring history of the herbal therapy itself. Participants were in favour of a future integrative health care system provided this did not interfere with the unique attributes of herbalism that make it distinct from conventional medicine.

Geographic hierarchies of diagnostic practice style in cerebrovascular disease

Diagnostic practice style describes the ways in which physicians diagnose information about disease. Like practice style effects in general, diagnostic practice style effects may emerge as the result of training, inter-personal relationships between professionals, medical enthusiasm for particular diagnoses and patient-physician interactions. In this study we analyze the ways in which patterns of diagnostic practice style associated with cerebrovascular disease varies at different socio-geographical scales in the province of Alberta, Canada. We use hierarchical linear models to partition a measure of diagnostic practice style into four levels of observation: the physician level, the facility level, the municipality level and the regional (census division) level. We model a variety of fixed effects related to physician attributes, their practice, the facilities they work in and the municipalities within which their facilities operate. Our results suggest that attributes related to physicians and the facilities and municipalities in which they work all contribute to patterns of diagnostic practice style. Physicians working in rural and urban municipalities have different practice style patterns even after controlling for the types of facilities they work in, their professional medical specialization and their workload. Similar to other research, our results reveal that physicians have different diagnostic practice styles with members of the same sex than members of the opposite sex. Geographic variations in diagnostic practice style may obscure changes in the epidemiology of cerebrovascular disease in rural communities, and provide indirect evidence that the quality and/or timeliness of diagnosis may be worse in rural Alberta.

Management of depression by general practitioners: impact of physician gender

OBJECTIVE

The aim of the present study was to determine whether anecdotal claims of gender differences in the treatment of depression by general practitioners (GPs) existed in practice.

METHOD

Referral letters from 100 GPs to a specialized psychiatric depression clinic were analysed by word count and gender of referrer. Second, a Web-based survey of 517 participants examined the impact of GP gender in terms of levels of management nuances.

RESULTS

The first study established that female GPs wrote distinctly longer referral letters. The second study identified that female GPs were seen as distinctly more caring over a range of parameters and identified the impact of some GP-patient gender differences.

CONCLUSIONS

Reasons why female GPs are viewed as more caring - and any impact on the management of those with a depressive disorder - would benefit from refined investigation.

An Analysis of the Impact of Gender on Physician Practice Patterns

Through analysis of Community Tracking Study Physician Survey, a nationally representative survey of U.S. physicians, we find that women physicians are significantly less satisfied with time for patients than their male colleagues. Among primary care physicians, about one third of the gender difference is explained by physician attributes, practice characteristics, geographical location and patient profiles. Control variables explain all of the gender gap among specialist physicians. Among primary care physicians, the effects of practice type and perceptions of patient complexity on satisfaction with time for patients are mediated by physician gender. Among specialist physicians, gender interacts with practice ownership and hours spent in medically related activity to determine satisfaction with time for patients.

Gender differences in patient-provider symptom agreement in reporting respiratory complaints on a questionnaire

BACKGROUND

Men and women communicate differently, but it is unclear whether this influences health care outcomes.

OBJECTIVE

Because women patients frequently choose women health care providers, we examined whether this preference was affected by communication styles. We focused on communication of disease-specific symptoms, hypothesizing that symptom agreement between women patients and women health care providers would be greater than between other patient-provider gender combinations.

METHODS

Patients attending outpatient clinics were recruited as part of a study of respiratory illness at 7 university-affiliated sites during 3 consecutive influenza seasons (2000-2003). Individuals aged > or = 19 years were offered enrollment if they sought care for cold or flu symptoms at a participating study site. Patients were eligible to participate in the study if they reported any 1 of 6 symptoms: cough, runny nose, fever (subjective), muscle aches, sore throat, and/or exhaustion. Using separate questionnaires, patients and their health care providers recorded the patients' respiratory symptoms (as present or absent). Patients recorded their symptoms before visiting their health care provider, and providers recorded patient symptoms after the visit. Symptom agreement was compared using general estimating equations across all gender combinations.

RESULTS

A total of 327 patients (220 women, 107 men) and 84 health care providers (37 women, 47 men) participated in the study. Overall symptom agreement for all patient-provider gender combinations was 81.9% (95% CI, 79.6%-84.2%). For each symptom, the observed agreement significantly exceeded the agreement expected by chance alone (P < 0.001 for all symptoms except "no energy," which was P = 0.023). The male-male pairing of patient and provider was more likely to agree on a symptom than were the other gender combinations, although not statistically significantly more so than the female-female pairing.

CONCLUSIONS

In this survey of patients with respiratory illness, there was no significant difference in symptom agreement for most symptoms between the male-male and female-female patient-provider combinations. Based on these findings, symptom agreement alone does not explain why women patients select women health care providers.