Clinician gender is more important than gender concordance in quality of HIV care

Beran, Mary Sue; Cunningham, William E.; Landon, Bruce E.; Wilson, Ira B.; Wong, Mitchell D.

doi:10.1016/s1550-8579(07)80010-6

Cited by 19 publications

(21 citation statements)

References 30 publications

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“…25 . This may eventually be explained by the fact that, by activating GPs' gender schemas (i.e., cognitive structures that encompass learned knowledge about the meanings of being a man or a woman) 7 , such gendered clinical situations may increase the likelihood of GPs' decisions being influenced by their This is a postprint version of a manuscript published in THE JOURNAL OF PAIN available at http://dx.doi.org/10.1016/j.jpain.2013.03.004 gender identities/stereotypes 17 , accounting for sex-related differences in GPs' medical decisions.…”

Section: Predictors Of Non-pharmacological Treatment Prescriptions (Nmentioning

confidence: 99%

“…10,33,45,46,47 . However, the effect of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been less explored 7,11,12,49 , especially in pain management contexts. This paper contributes to bridging this gap.…”

Section: Introductionmentioning

confidence: 99%

“…With the help of a GP, the vignettes were slightly modified from previously tested vignettes used in former studies we conducted with nurses. 7,8 .…”

mentioning

confidence: 99%

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Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Bernardes

Costa

Carvalho

2013

The Journal of Pain

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The impact of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been underexplored, especially in a pain context. Also, few studies have analyzed whether physicians sex moderates the influence of patients' or clinical situations' characteristics on pain management practices or its mediating processes. Therefore, our goal was to explore whether physician sex moderates the: a) effects of patient's (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain (CLBP), and b) mediating role of pain credibility judgments and psychological attributions on these effects. 310 general practitioners (GPs; 72.6% women) participated in a betweensubjects design, 2 (patient's pain behaviors) x 2 (EP) x 2 (GP sex) x 2 (patient sex). GPs were presented with vignettes depicting a fe(male) CLBP patient, with(out) distress and with(out) EP (e.g., herniated disc). GPs judged the patient's pain and the probability of treatment prescriptions and referrals. Results showed that EP had a larger effect on male than on female physicians' referrals to psychology/psychiatry. Also, GP sex moderated the pain judgments that accounted for the effect of EP and pain behaviors on prescriptions. These findings suggest framing medical decision making as a process influenced by gender assumptions. This is a postprint version of a manuscript published in THE JOURNAL OF PAIN available at http://dx.doi. org/10.1016/j.jpain.2013.03.004 3 Perspective This paper shows that physician sex moderates the influence of clinical cues on pain management practices and the mediating role of pain judgments on these effects. It may potentially increase clinicians' awareness of the influence of gender assumptions on pain management practices and contribute to the development of more gender sensitive services.

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Section: Predictors Of Non-pharmacological Treatment Prescriptions (Nmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Bernardes

Costa

Carvalho

2013

The Journal of Pain

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“…27 * Some studies have found that provider gender and race affect patient satisfaction and health service utilization. [29][30][31] …”

Section: Changing Providers: New Responsibilities Impending Shortagesmentioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care-and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.

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“…Fewer studies examine if there are differences between male and female physicians in more technical qualities of care, such as performing diagnostic procedures and initiating appropriate therapies. 6,9 However, one recent study suggests that female physicians may provide higher-quality diabetes care for their patients. 10 There are well-documented disparities in cardiovascular disease (CVD) risk factor levels, treatment, and outcomes for female patients.…”

mentioning

confidence: 99%

The Association of Patient-Physician Gender Concordance with Cardiovascular Disease Risk Factor Control and Treatment in Diabetes

Schmittdiel

Traylor

Uratsu

et al. 2009

Journal of Women's Health

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Background: Gender concordance between patients and their physicians is related to prevention screening and other quality indicators. Research suggests female physicians may place greater emphasis on preventive care than male physicians; however, little is known about whether physician gender and patient-physician gender concordance are associated with cardiovascular disease (CVD) risk factor levels and treatment. Our objective was to examine associations between patient gender, physician gender, and their interaction with CVD risk factor control, medication adherence, and treatment intensification in diabetes. Methods: In this study, 157,458 Kaiser Permanente Northern California adult diabetes patients with a primary care physician (PCP) were assessed for above target levels of hemoglobin A1c (HbA1c) (8%), low-density lipoprotein cholesterol (LDL-C) (100 mg=dL), and systolic blood pressure (SBP 130 mm Hg) in 2005. Medication adherence and appropriate CVD treatment intensification were assessed using pharmacy data. Probit models assessed the adjusted marginal effects of patient gender, PCP gender, and their interaction on control, adherence, and intensification. Results: Female patients had lower adjusted rates of LDL-C (46% vs. 55%, p < 0.001) and SBP control (52% vs. 60%, p < 0.001) than males. Female patients of female PCPs had the highest adjusted rates of HbA1c control of the four patient-physician gender dyads (70% vs. 66%-68%, p < 0.05). Male patients were more likely than female patients to receive treatment intensification for high SBP (60% vs. 57%, p < 0.001). Female PCPs were more likely than their male counterparts to intensify therapy for hyperlipidemia and hypertension. Conclusions: Patient and physician gender and gender concordance are modestly associated with CVD risk factor control and treatment in diabetes. Further understanding of these differences could lead to improved CVD outcomes for women.

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Clinician gender is more important than gender concordance in quality of HIV care

Cited by 19 publications

References 30 publications

Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

The Association of Patient-Physician Gender Concordance with Cardiovascular Disease Risk Factor Control and Treatment in Diabetes

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