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.