Patient and physician gender concordance in preventive care in university primary care settings

Abstract

Background: The proportion of female physicians working in primary care medicine has increased for several decades. Several studies have reported physician gender differences in preventive health care received by patients, especially for gender-specific preventive services. However, limited data exist on the role of patient and physician gender and gender concordance in the broad spectrum of preventive care. Therefore, we assessed the association between physician gender, patient-physician gender concordance, and the quality of preventive care in Swiss university primary care settings. Methods: We performed a retrospective cohort study of 1001 randomly selected patients aged 50-80 years from four Swiss university primary care settings. We used indicators derived from RAND's Quality Assessment Tools indicators and calculated percentages of recommended preventive care (such as behavioral counseling and cancer screening) according to physician and patient gender. We used a hierarchical multivariate logistic regression, adjusting for patients' age and occupation, and for physicians' age, function and centre (both as random factors). Results: 1001 patients (mean age 63.5 years, 557 male) were followed by 189 physicians (mean age 34.2 years, 90 male, 94.7% residents). After multivariate adjustment, female patients received less recommended preventive care than male patients (88.4% vs. 91.3%, p<0.001). Female physicians provided significantly more preventive care than male physicians (p=0.04) to both female (88.8% vs. 87.7%) and male patients (91.6% vs. 90.7%). We found no evidence that preventive care differed among gender concordant and discordant patient-physician pairs (p for interaction = 0.78). Female physicians provided particularly more recommended cancer screening (colon cancer, breast cancer) than male physicians (81.2% vs. 75.3%, p=0.01). Conclusion: In Swiss primary care settings, female patients receive less preventive care than male patients. Furthermore, female physicians provide significantly more preventive care than their male colleagues, particularly for cancer screening. This study suggests that greater attention should be paid to female patients in preventive health care. Further studies are needed to understand why female physicians tend to provide better preventive care.

Impact of Patient–Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey

“…This is consistent with the results reported by Jerant and colleagues that women with female physicians were more likely to report up-to-date mammography (23). Another retrospective study conducted in 10,001 patients in Switzerland reported that female physicians provided significantly more preventive care services than male physicians to both female (66.7% vs. 63.6%) and male patients (73.4% vs. 70.7%) but found no evidence of gender concordance on cancer screening (35). However, that study did not include cervical cancer screening (using Pap tests) and was done in a university primary care setting where almost all patients were treated in the first instance by residents at the end of their postgraduate training.…”

Disengagement of general practitioners in cervical cancer screening

“…They may have more interest in gynecological cancers because of a shared susceptibility to the disease (Woodward et al, 1996). Women physicians may have been generally socialized to focus more attention toward preventive care, with more communication with patients and longer visit duration (Woodward et al, 1996;Roter and Hall, 2004;Krähenmann-Müller et al, 2014). Differences in the perception of what is most important in the work of the physician may matter: one study carried out in Norwegian medical schools found that, for women physicians, work satisfaction was associated with perceived clinical skills whereas for male physicians it was associated with feeling well with their peers (Finset et al, 2005).…”

Primary prevention of cardiovascular disease: More patient gender-based differences in risk evaluation among male general practitioners

“…6,7 Secondary cardiovascular prevention (i.e., after a first cardiovascular event) is more frequent for men: their risk factors are monitored better than those of women. [8][9][10][11][12] Most cardiovascular events, however, occur in people without known cardiovascular disease (88% in France 13 ). To our knowledge, only one study has examined gender differences exclusively for primary prevention of cardiovascular diseases; it reported results that differed according to the preventative procedures considered.…”