A comprehensive assessment of family physician gender and quality of care: a cross-sectional analysis in Ontario, Canada

Published: March 1, 2016
Category: Bibliography > Papers
Authors: Dahrouge S, Hogg W, Mercer J, Muggah E, Ponka D, Russell G, Seale E, Younger J
Countries: Canada
Language: English
Types: Care Management, Population Health
Settings: Hospital, PCP

Med Care 54:277-286.

University of Ottawa, Ottawa, ON, Canada; Institute of Clinical Evaluative Sciences, Ottawa, ON, Canada; Queen’s University, Kingston, ON, Canada; Monash University, Clayton, Vic, Australia; Ottawa Hospital Research Institute

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.

PMID: 26765146

Canada,Gender,Care Management,Performance Assessment,Primary Care,Adult,Age Factors,Aged,Chronic Disease/therapy,Continuity of Patient Care/statistics & numerical data,Cross-Sectional Studies,Early Detection of Cancer/statistics & numerical data,Health Services Accessibility/statistics & numerical data,Middle Aged,Ontario,Referral and Consultation,Residence Characteristics,Sex Factors,Socioeconomic Factors

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