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A Comprehensive Assessment of Family Physician Gender and Quality of Care

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Background:

Studies evaluating primary care quality across physician gender are limited to primary and secondary prevention.

Objectives:

Investigate the relationship between family physician gender and quality of primary care using indicators that cover 5 key dimensions of primary care.

Research Design:

Cross-sectional analysis using linked health administrative datasets (April 1, 2008 to March 31, 2010).

Subjects:

All family physicians working in the 3 main primary care models in the province of Ontario (Canada), providing general care and having a panel size >1200.

Measures:

Indicators of cancer screening (3), chronic disease management (9), continuity (2), comprehensiveness (2), and access (5).

Results:

A total of 4195 physicians (31% female) were eligible. Adjusting for provider and patient factors, patients of female physicians were more likely to have received recommended cancer screening (odds ratios [95% confidence interval (CI)] (OR) range: 1.24 [1.18–1.30], 1.85 [1.78–1.92]) and diabetes management (OR: 1.04 [1.01–1.08], 1.28 [1.05–1.57]). They had fewer emergency room visits (rate ratio [95% CI] (RR) range: 0.83 [0.79–0.87]) and hospitalizations (RR: 0.89 [0.86–0.93]), and higher referrals (RR: 1.12 [1.09–1.14]). There was evidence of effect modification by patient gender (female vs. male) for hospitalization (RR: 0.74 [0.70–0.79] vs. 0.96 [0.90–1.02]) and emergency room visits (RR: 0.84 [0.81–0.88] vs. 0.98 [0.94–1.01]). Lower emergency room visits were also more evident in more complex patients of female physicians. There were no significant differences in the continuity or comprehensiveness measures.

Conclusions:

The indicators assessed in this study point to a benefit for patients under the care of female physicians. Potential explanations are discussed.
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Keywords: access; cancer screening; care; chronic disease management; comprehensiveness; continuity; family medicine; gender; primary care; quality

Document Type: Research Article

Affiliations: 1: Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Institute of Population Health, Department of Epidemiology and Community Medicine, University of Ottawa, Institute of Clinical Evaluative Sciences, Ottawa 2: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Queen’s University, Kingston, ON, Canada 3: Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Institute of Population Health, Department of Epidemiology and Community Medicine, University of Ottawa 4: Southern Academic Primary Care Research Unit. School of Primary Health Care, Monash University, Clayton, Vic, Australia 5: Institute of Clinical Evaluative Sciences, Ottawa, Ottawa Hospital Research Institute 6: Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute 7: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute 8: Bruyère Family Medicine Centre, Ottawa, ON, Canada

Publication date: 01 March 2016

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