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Prevalence and associations of gender concordance in general practice consultations: a cross-sectional analysis.

Allison Thomson, Simon Morgan, Amanda Tapley, Mike van Driel, Kim Henderson, Chris Oldmeadow, Jean Ball, Neil Spike, Lawrie McArthur, Peter O'Mara, John Scott, Parker Magin

Abstract


Rationale, aims and objectives: Gender effects on physician-patient interactions are well-established and gender concordance of the physician-patient dyad influences consultation dynamics, person-centeredness and outcomes. We aimed to establish the prevalence and associations of gender-concordant and gender-discordant consultations of general practice (family medicine) trainees and to compare outcomes of gender-concordant and gender-discordant consultations.

Method: A cross-sectional analysis from an ongoing cohort study. The outcome measure was whether a consultation included a gender concordant (female-female, male-male) or discordant (male-female, female-male) physician-patient dyad. Independent variables related to patient, physician (registrar), practice, consultation content and consultation outcome.

Results: Five hundred and ninety-two general practice (GP) registrars (trainees) in 4 of Australia’s 17 regional training programs provided data on 56,234 individual consultations. Sixty-two point nine percent of consultations were gender-concordant (73.5% female-female, 26.5% male-male) and 37.1% were gender-discordant (47.0% male physician-female patient, 53% female physician-male patient). Associations of having a gender-concordant consultation were patient female gender and younger age (<55), the patient not being new to the registrar and the registrar being part-time, younger and having worked at the practice previously. Addressing a reproductive/contraceptive/ genital problem was associated with gender concordance. Gender-concordant consultations were  ‘complex’: significantly longer than gender-discordant consultations, addressed a greater number of problems, resulted in more pathology ordered, more follow-up organised and more learning goals generated.

Conclusions: Gender-concordant consultations may be more complex and gender-concordance is ‘sought’ by patients rather than being random.  Thus, efforts could be made in general practice to provide access to both male and female GPs, especially for female patients or groups or patients with particular needs.

 


Keywords


Consultation dynamics, cultural sensitivity, dyadic preference, family medicine, general practice, patient choice, person-centered healthcare, physician's practice patterns, physician-patient relations, physicians, women patients

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References


Roter, D.L., Hall, J.A. & Aoki, Y. (2000). Physician gender effects in medical communication: a meta-analytic review. Journal of the American Medical Association 288, 756-764.

Roter, D.L. & Hall, J.A. (2004). Physician gender and patient-centered communication: a critical review of empirical research. Annual Review of Public Health 25, 497-519.

Franks, P. & Bertakis, K.D. (2003). Physician gender, patient gender, and primary care. Journal of Women’s Health 12, 73-80.

Hall, J.A. & Roter, D.L. (2002). Do patients talk differently to male and female physicians? A meta-analytic review. Patient Education and Counseling 48, 217-224.

Bertakis, K.D. (2009). The influence of gender on the doctor-patient interaction. Patient Education and Counseling 76, 356-360.

Jerant, A., Bertakis, K.D., Fenton, J.J. & Franks, P. (2013). Gender of physician as the usual source of care and patient health care utilization and mortality. Journal of the American Board of Family Medicine 26, 138-148.

Graffy, J. (1990). Patient choice in a practice with men and women general practitioners. British Journal of General Practice 40, 13-15.

Ahmad, F., Gupta, H., Rawlins, J. & Stewart, D.E. (2002). Preferences for gender of family physician among Canadian European-descent and South-Asian immigrant women. Family Practice 19, 146-153.

Elstad, J,I. (1994). Women's priorities regarding physician behavior and their preference for a female physician. Women’s Health 21, 1-19.

Gerbert, B., Berg-Smith, S., Mancuso, M., Caspers, N., Danley, D., Herzig, K. & Brand, R. (2003). Video study of physician selection: preferences in the face of diversity. Journal of Family Practice 52, 552-559.

Perry, R.C., Chien, A.T., Walker, W.J., Fisher, T.L. & Johnson, W.E. (2010). African American adolescent males' views on doctors and the health care system. Journal of the National Medical Association 102, 312-320.

Sandhu, H., Adams, A., Singleton, L., Clark-Carter, D. & Kidd. J. (2009). The impact of gender dyads on doctor-patient communication: a systematic review. Patient Education and Counseling 76, 348-355.

Bertakis, K.D. & Azari, R. (2012). Patient-centered care: the influence of patient and resident physician gender and gender concordance in primary care. Journal of Women’s Health 21, 326-333.

Bertakis, K.D., Franks, P. & Epstein, R.M. (2009). Patient-centered communication in primary care: physician and patient gender and gender concordance. Journal of Women’s Health 18, 539-545.

Pietrolongo, E., Giordano, A., Kleinefeld, M., Confalonieri, P., Lugaresi, A., Tortorella, C., Pugliatti, M., Radice, D., Goss, C. Heesen, C., Solari, A. & Auto MS group. (2013). Decision-making in multiple sclerosis consultations in Italy: third observer and patient assessments. PLoS One 8, e60721.

Flocke, S.A. & Gilchrist, V. (2005). Physician and patient gender concordance and the delivery of comprehensive clinical preventive services. Medical Care 43, 486-492.

Jerant, A., Bertakis, K.D., Fenton, J.J., Tancredi, D.J. & Franks, P. (2011). Patient-provider sex and race/ethnicity concordance: a national study of healthcare and outcomes. Medical Care 49, 1012-1020.

Pickett-Blakely, O., Bleich, S.N. & Cooper, L.A. (2011). Patient-physician gender concordance and weight-related counseling of obese patients. American Journal of Preventive Medicine 40, 616-619.

Shires, D.A., Stange, K.C., Divine, G., Ratliff, S., Vashi, R., Tai-Seale, M. & Lafata, J.E. (2012). Prioritization of evidence-based preventive health services during periodic health examinations. American Journal of Preventive Medicine 42, 164-173.

McAlearney, A.S., Oliveri, J.M., Post, D.M., Song, P.H., Jacobs, E., Waibel, J., Harrop, J.P., Steinman, K. & Paskett, E.D. (2012). Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study. Patient Education and Counseling 86, 120-126.

Schmittdiel, J.A., Traylor, A., Uratsu, C.S., Mangione, C.M., Ferrara, A. & Subramanian, U. (2009). The association of patient-physician gender concordance with cardiovascular disease risk factor control and treatment in diabetes. Journal of Women’s Health 18, 2065-2070.

Chan, K.S., Bird, C.E., Weiss, R., Duan, N., Meredith, L.S. & Sherbourne, C.D. (2006). Does patient-provider gender concordance affect mental health care received by primary care patients with major depression? Women’s Health Issues 16, 122-132.

Carroll, J., Epstein, R., Fiscella, K., Gipson, T., Volpe, E. & Jean-Pierre, P. (2007). Caring for Somali women: implications for clinician-patient communication. Patient Education and Counseling 66, 337-345.

Ahmad, W.I., Kernohan, E.E. & Baker, M.R. (1991). Patients' choice of general practitioner: importance of patients' and doctors' sex and ethnicity. British Journal of General Practice 41, 330-331.

Ahmad, W.I., Kernohan, E.E. & Baker, M.R. (1989). Patients' choice of general practitioner: influence of patients' fluency in English and the ethnicity and sex of the doctor. Journal of the Royal College of General Practitioners 39, 153-155.

Morgan, D.L., Slade, M.D. & Morgan, C.M. (1997). Aboriginal philosophy and its impact on health care outcomes. Australian and New Zealand Journal of Public Health 21, 597-601.

Kelly, J. & Luxford, Y. (2007). Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young Aboriginal women in Adelaide. Collegian 14, 15-20.

Hall, J.A., Blanch-Hartigan, D. & Roter, D.L. (2011). Patients' satisfaction with male versus female physicians: a meta-analysis. Medical Care 49, 611-617.

Morgan, S., Magin, P.J., Henderson, K.M., Goode S.M., Scott, J., Bowe, S.J., Regan, C.M., Sweeney, K.P., Jackel, J. & Driel, M.L. (2012). Study protocol: the Registrar Clinical Encounters in Training (ReCEnT) study. BMC Family Practice 13, 50.

Britt, H. (1997). A new coding tool for computerised clinical systems in primary care - ICPC plus. Australian Family Physician 26 (Supplement 2) S79-82.

O'Halloran, J., Miller, G.C. & Britt, H. (2004). Defining chronic conditions for primary care with ICPC-2. Family Practice 21, 381-386.

Australian Bureau of Statistics. Australian Standard Geographical Classification (ASGC) - 2006. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/1AE106C101420508CA2571A900170741 : [accessed 15/1/15].

Australian Bureau of Statistics. 2039.0 - Information Paper: An Introduction to Socio-economic Indexes of Areas (SEIFA), 2006. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/2039.0/ [accessed 15/1/15].

Blake, R.L., Jr. (1990). Gender concordance between family practice residents and their patients in an ambulatory-care setting. Academic Medicine 65, 702-703.

Orzano, A.J. & Cody, R.P. (1995). Gender concordance between family practice residents and diagnoses in an ambulatory setting. Family Medicine 27, 440-443.

Bonevski, B., Magin, P., Horton, G., Foster, M. & Girgis, A. (2011). Response rates in GP surveys - trialling two recruitment strategies. Australian Family Physician 40, 427-430.

Australian Medical Workforce Advisory Committee. (2005). The General Practice Workforce in Australia: Supply and Requirements to 2013, AMWAC Report 2005.2, Sydney.

Wensing, M., Hermsen, J., Grol, R. & Szecsenyi, J. (2008). Patient evaluations of accessibility and co-ordination in general practice in Europe. Health Expectations 11, 384-390.

Campbell, J.L., Ramsay, J. & Green, J. (2001). Practice size: impact on consultation length, workload, and patient assessment of care. British Journal of General Practice 51, 644-650.




DOI: http://dx.doi.org/10.5750/ejpch.v3i4.1016

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