Background: Studies evaluating primary care quality across physician gender are limited to primary and secondary prevention.
Objectives: Investigate the relationship between family physician gender and quality of primary care using indicators that cover 5 key dimensions of primary care.
Research Design: Cross-sectional analysis using linked health administrative datasets (April 1, 2008 to March 31, 2010).
Subjects: All family physicians working in the 3 main primary care models in the province of Ontario (Canada), providing general care and having a panel size >1200.
Measures: Indicators of cancer screening (3), chronic disease management (9), continuity (2), comprehensiveness (2), and access (5).
Results: A total of 4195 physicians (31% female) were eligible. Adjusting for provider and patient factors, patients of female physicians were more likely to have received recommended cancer screening (odds ratios [95% confidence interval (CI)] (OR) range: 1.24 [1.18–1.30], 1.85 [1.78–1.92]) and diabetes management (OR: 1.04 [1.01–1.08], 1.28 [1.05–1.57]). They had fewer emergency room visits (rate ratio [95% CI] (RR) range: 0.83 [0.79–0.87]) and hospitalizations (RR: 0.89 [0.86–0.93]), and higher referrals (RR: 1.12 [1.09–1.14]). There was evidence of effect modification by patient gender (female vs. male) for hospitalization (RR: 0.74 [0.70–0.79] vs. 0.96 [0.90–1.02]) and emergency room visits (RR: 0.84 [0.81–0.88] vs. 0.98 [0.94–1.01]). Lower emergency room visits were also more evident in more complex patients of female physicians. There were no significant differences in the continuity or comprehensiveness measures.
Conclusions: The indicators assessed in this study point to a benefit for patients under the care of female physicians. Potential explanations are discussed.
*Department of Family Medicine, University of Ottawa
†C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute
‡Institute of Population Health
§Department of Epidemiology and Community Medicine, University of Ottawa
∥Institute of Clinical Evaluative Sciences, Ottawa
¶Queen’s University, Kingston, ON, Canada
#Southern Academic Primary Care Research Unit. School of Primary Health Care, Monash University, Clayton, Vic, Australia
**Ottawa Hospital Research Institute
††Bruyère Family Medicine Centre, Ottawa, ON, Canada
Supported by the Canadian Institutes of Health Research (FRN 102660). This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
The authors declare no conflict of interest.
Reprints: Simone Dahrouge, PhD, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON, Canada K1R 6M1. E-mail: sdahrouge@bruyere.org.
