An evaluation of gender equity in different models of primary care practices in Ontario

BMC Public Health

Research Article

Simone Dahrouge¹  Meltem Tuna¹  William Hogg²  Grant Russell²  Rose Anne Devlin³  Peter Tugwell⁴  Elisabeth Kristjansson⁵ 

[1]C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street, Ontario, Ottawa, Canada

[2]C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street, Ontario, Ottawa, Canada

[3]Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ontario, Ottawa, Canada

[4]Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ontario, Ottawa, Canada

[5]Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ontario, Ottawa, Canada

[6]Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ontario, Ottawa, Canada

[7]Institute of Population Health, University of Ottawa, 1 Stewart St, Room 300, Ontario, Ottawa, Canada

[8]Institute of Population Health, University of Ottawa, 1 Stewart St, Room 300, Ontario, Ottawa, Canada

关键词: Primary Care Practice;    Community Health Centre;    Gender Equity;    Health Service Delivery;    Chronic Disease Management;   

DOI  :  10.1186/1471-2458-10-151

 received in 2009-09-22, accepted in 2010-03-23,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist.MethodsThis cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108).ResultsHealth service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC).ConclusionsThe observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued.

【 授权许可】

CC BY   
© Dahrouge et al; licensee BioMed Central Ltd. 2010