Review: Does Patient–Physician Gender Concordance Influence Patient Perceptions or Outcomes?
- The Cardiovascular Disease in Women Section of the American College of Cardiology recently conducted a systematic review of studies examining patient–provider sex/gender concordance, published in English between 2009 and 2019
- Only 13 relevant studies were identified, of which eight evaluated patient outcomes and five examined patient preferences; none were randomized controlled studies
- The data were mixed; six of the eight studies of patient outcomes found that patient–provider gender concordance did have an effect, but only two of five studies suggested gender concordance affects patient preferences
- The reviewers propose measures to increase gender diversity in the cardiologist workforce, improve medical training and increase research into patient–provider gender concordance
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Gender disparities in patient outcomes continue for many disorders, including in cardiology. For example, during acute myocardial infarction (AMI), women are consistently less likely than men to be referred for appropriate treatment and are less likely to receive guideline-recommended therapies after hospitalization.
Patient–provider gender discordance has been proposed as one contributor to these disparities. To investigate, the Cardiovascular Disease in Women Section of the American College of Cardiology recently conducted a systematic review of studies in any specialty that examined patient–provider sex/gender concordance.
In the Journal of the American College of Cardiology, Emily Lau, MD, fellow in the Division of Cardiology at the Corrigan Minehan Heart Center of Massachusetts General Hospital, and Malissa J. Wood, MD, co-director of the Corrigan Women's Heart Health Program, and colleagues report on the limited data available and present recommendations for improvement.
The group identified 13 relevant studies published in English between 2009 and 2019. Eight of them evaluated patient outcomes and five examined patient preferences. None were randomized controlled studies.
Six of the eight studies that evaluated patient outcomes found that patient–provider gender concordance did influence clinical outcomes.
Among 157,458 adults with diabetes who were treated by a primary care physician (PCP) in the Kaiser Permanente Northern California system, women were much less likely than men to receive treatment intensification for suboptimal risk factor control, particularly when the PCP was male. Furthermore, female PCPs were more likely than male PCPs to intensify therapy for hyperlipidemia and hypertension. The study is published in the Journal of Women's Health.
A study of patients admitted to Florida hospitals for AMI determined that mortality rates were highest for women treated by men, whereas mortality rates were similar for men and women if the treating physician was female. In fact, according to the report in PNAS, patient–provider gender concordance was associated with a 5.4% risk of death, whereas the baseline mortality rate was 11.9%.
The review suggested that gender concordance has less effect on patient preference: of the five studies, only two demonstrated an association.
For example, in a random sample of patients enrolled in North Carolina Medicaid's primary care case management program, patient–physician gender concordance did not improve patients' trust in their physician. These findings were published in Women & Health.
BMC Health Services Research reported that among inpatients in a general medicine hospital unit, TAISCH (Tool to Assess Inpatient Satisfaction with Care from Hospitalists) scores did not differ between gender-concordant and -discordant doctor–patient pairings.
Call to Action
To address gender-based disparities, the reviewers make recommendations for increasing gender diversity in the cardiologist workforce and improving medical training. They also call for scientifically rigorous sociological and behavioral studies designed to understand physician behaviors associated with improved patient outcomes in general, investigate further whether patient–provider gender concordance affects patient outcomes and determine the mechanisms underlying any such association.
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