Abstract
BackgroundWomen are disproportionately affected by cardiovascular disease, often experiencing poorer outcomes following a cardiovascular event. Evidence points to inequities in processes of care as a potential contributing factor. This study sought to determine whether any sex differences exist in adherence to process of care guidelines for cardiovascular disease within primary care practices in Ontario, Canada.MethodsThis is a secondary analysis of pooled cross-sectional baseline data collected through a larger quality improvement initiative known as the Improved Delivery of Cardiovascular Care (IDOCC). Chart abstraction was performed for 4,931 patients from 84 primary care practices in Eastern Ontario who had, or were at high risk of, cardiovascular disease. Measures examining adherence to guidelines associated with nine areas of cardiovascular care (coronary artery disease, peripheral vascular disease (PVD), stroke/transient ischemic attack, chronic kidney disease, diabetes, dyslipidemia, hypertension, smoking cessation, and weight management) were collected. Multivariable logistic regression analysis was performed to evaluate sex differences, adjusting for age, physician remuneration, and rurality.ResultsWomen were significantly less likely to have their lipid profiles taken (OR = 1.17, 95% CI 1.03-1.33), be prescribed lipid lowering medication for dyslipidemia (OR = 1.54, 95% CI 1.20-1.97), and to be prescribed ASA following stroke (OR = 1.56, 95% CI 1.39-1.75). Women with PVD were significantly less likely to be prescribed ACE inhibitors and/or angiotensin receptor blockers (OR = 1.74, 95% CI 1.25-2.41) and lipid lowering medications (OR = 1.95, 95% CI 1.46-2.62) or ASA (OR = 1.59, 95% CI 1.43-1.78). However, women were more likely to have two blood pressure measurements taken and to be referred to a dietician or weight loss program. Male patients with diabetes were less likely to be prescribed glycemic control medication (OR = 0.84, 95% CI 0.74-0.86).ConclusionsSex disparities exist in the quality of cardiovascular care in Canadian primary care practices, which tend to favour men. Women with PVD have a particularly high risk of not receiving appropriate medications. Our findings indicate that improvements in care delivery should be made to address these issues, particularly with regard to the prescribing of recommended medications for women, and preventive measures for men.
Highlights
Women are disproportionately affected by cardiovascular disease, often experiencing poorer outcomes following a cardiovascular event
Few studies have sought to examine whether patients are receiving a comparable quality of care across primary care practices, and if not, which patient-level characteristics are associated with lower quality care in order to address potential inequities
We are unable to determine from this data whether the care indicators in question were offered to but refused by the patient, as the chart data only indicated whether they were performed. In conclusion, these findings highlight some important gaps in the quality of cardiovascular disease care in primary care practices, with implications for both women and men
Summary
Women are disproportionately affected by cardiovascular disease, often experiencing poorer outcomes following a cardiovascular event. Primary care has undergone significant reform within Canada, as many provinces have instituted novel physician funding approaches, team-based care models, and placed a greater emphasis on the role of primary care in chronic disease management Despite this energetic reform, few studies have sought to examine whether patients are receiving a comparable quality of care across primary care practices, and if not, which patient-level characteristics are associated with lower quality care in order to address potential inequities. A review of patients with diabetes in Sweden reported women as having more frequent outpatient contacts, less patient satisfaction, and a lower health-related quality of life than men with diabetes [6]; no gender differences were found in their levels of glycemic control Another recent study examining gender equity in primary care practices by remuneration structure found that women attending fee-for-service practices were significantly less likely to have received recommended care for chronic diseases, a difference not observed in capitation-based practices [7]
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