Gender inequalities in COPD decision-making in primary care

LÓPEZ FERNÁNDEZ, LUIS ANDRÉS; DELGADO, ANA; GIL GARRIDO, NATALIA; SALETTI CUESTA, LORENA; LUNA, JUAN DE DIOS

RESPIRATORY MEDICINE.

W B SAUNDERS CO LTD

Lugar: Londres; Año: 2016 vol. 114 p. 91 - 96

0954-6111

COPD is a frequent severe illness that increasinglyaffects females. Gender inequalities have been reported in COPD care.Objective: To analyze decision-making in primary care for men and womenwith identical COPD as a function of the gender of the family physician(FP).Methods: Cross-sectional, multicenter study in 457 Andalusian FPs, usinga self-administered vignette-based questionnaire on COPD featuring a maleor female patient, with four variables on clinical reasoning: "tobacco asmost important risk factor (RF)", "ordering of spirometry", "COPD as mostlikely diagnosis", and "referral". Multilevel logistic regressionanalysis.Results: Response rate was 67.4% (308/457). In analysis of the four FPgender-patient gender dyads, tobacco was more frequently considered aspriority RF for the man than for the woman in the vignette by female(95.6%vs.67.1%) and male (79.8%vs.62.5%) FPs. COPD was more frequentlythe most likely diagnosis for the man versus woman by female(84.4%vs.49.9%) and male (78.5%vs.57.8%) FPs. Male FPs more frequentlyordered spirometry for the man versus woman (68.1%vs.46.8%). There wereno differences in referral between male and female patients. Male FPswere more likely than female FPs to consider tobacco as priority RF forthe man (p=002). Female FPs were more likely than male FPs to refer theman (22.5%vs.8%).Conclusions: There may be gender inequalities in primary care for COPD inour setting. Diagnostic and therapeutic efforts appear lower in femalepatients. Male and female FPs only differed in care of the male patient,indicating FP gender-patient gender interaction.