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Wenger NK, Williams OO, Parashar S. SMARTWOMAN™: Feasibility assessment of a smartphone app to control cardiovascular risk factors in vulnerable diabetic women. Clin Cardiol 2019; 42:217-221. [PMID: 30471130 PMCID: PMC6712310 DOI: 10.1002/clc.23124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/HYPOTHESIS SMARTWOMAN™ was designed to develop and assess the feasibility of a smartphone app to control cardiovascular risk factors in vulnerable diabetic women. METHODS Fourteen African-American women with diabetes and without known cardiovascular disease were enrolled. A weight-scale, glucometer, sphygmomanometer, and FitBit were synchronized to the smartphone, and text messaging was provided. Follow-up was 6 months. RESULTS Patients were able to follow instructions for app use and device prompts. Weekly device reporting was 85% for blood glucose, 82.5% for daily steps, and 77% for systolic blood pressure. Patient engagement levels were 85% to 100% at 1 month and 50% to 78% at month 6. The majority reported text messages to be useful, easy to understand, and appropriate in frequency. The women indicated on the exit questionnaire that study participation increased their motivation and ability to take charge of their health. CONCLUSIONS Use of a smartphone app to control cardiovascular risk factors appears feasible in a population of vulnerable indigent African-American diabetic women, resulted in increased patient satisfaction and positive reinforcement to healthy behaviors, and warrants a larger clinical outcome trial.
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Affiliation(s)
- Nanette K Wenger
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory Heart and Vascular Center, Emory Women's Heart Center, Atlanta, Georgia
| | | | - Susmita Parashar
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory Women's Heart Center, Atlanta, Georgia
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Mapping the Gaps: Gender Differences in Preventive Cardiovascular Care among Managed Care Members in Four Metropolitan Areas. Womens Health Issues 2018; 28:446-455. [PMID: 29929865 DOI: 10.1016/j.whi.2018.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/21/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prior research documents gender gaps in cardiovascular risk management, with women receiving poorer quality routine care on average, even in managed care systems. Although population health management tools and quality improvement efforts have led to better overall care quality and narrowing of racial/ethnic gaps for a variety of measures, we sought to quantify persistent gender gaps in cardiovascular risk management and to assess the performance of routinely used commercial population health management tools in helping systems narrow gender gaps. METHODS Using 2013 through 2014 claims and enrollment data from more than 1 million members of a large national health insurance plan, we assessed performance on seven evidence-based quality measures for the management of coronary artery disease and diabetes mellitus, a cardiac risk factor, across and within four metropolitan areas. We used logistic regression to adjust for region, demographics, and risk factors commonly tracked in population health management tools. FINDINGS Low-density lipoprotein (LDL) cholesterol control (LDL < 100 mg/dL) rates were 5 and 15 percentage points lower for women than men with diabetes mellitus (p < .0001), and coronary artery disease (p < .0001), respectively. Adjusted analyses showed women were more likely to have gaps in LDL control, with an odds ratio of 1.31 (95% confidence interval, 1.27-1.38) in diabetes mellitus and 1.88 (95% confidence interval, 1.65-2.10) in coronary artery disease. CONCLUSIONS Given our findings that gender gaps persist across both clinical and geographic variation, we identified additional steps health plans can take to reduce disparities. For measures where gaps have been consistently identified, we recommend that gender-stratified quality reporting and analysis be used to complement widely used algorithms to identify individuals with unmet needs for referral to population health and wellness behavior support programs.
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Giustino G, Redfors B, Mehran R, Kirtane AJ, Baber U, Généreux P, Witzenbichler B, Neumann FJ, Weisz G, Maehara A, Rinaldi MJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri EL, Brodie BR, Stuckey TD, Dangas GD, Brener SJ, Ozgu Ozan M, Stone GW. Sex differences in the effect of diabetes mellitus on platelet reactivity and coronary thrombosis: From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study. Int J Cardiol 2018; 246:20-25. [PMID: 28867009 DOI: 10.1016/j.ijcard.2017.05.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/22/2017] [Accepted: 05/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Whether the consequences of diabetes mellitus (DM) are worse for women than for men treated with drug-eluting stents (DES) and antiplatelet therapy remain unclear. METHODS Patients from the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents study were stratified according to sex and DM status. We investigated the sex-specific effect of DM on high on-clopidogrel platelet reactivity (HPR), defined as a P2Y12 reaction units ≥208, and the adjusted association of DM on the 2-year risk for coronary thrombotic events (CTE), defined as spontaneous myocardial infarction or definite or probable stent thrombosis. RESULTS Out of 8582 patients included in the study, 829 were women with DM (9.6%) and 1954 were men with DM (16.2%). The prevalence of insulin-treated DM (ITDM) was greater in women (p<0.0001). By multivariable logistic regression, DM was associated with a greater likelihood of HPR that was uniform between sexes (pint=0.88). Following adjustment for baseline variables and HPR, in women a stepwise increase in risk for CTEs was observed in the transition from no DM to non-ITDM (NITDM) (adjusted hazard ratio [adjHR]: 1.31; 95% CI: 0.78-2.18) to ITDM (adjHR: 2.69; 95% CI: 1.23-3.45). This increase in risk associated with subtypes of DM was of smaller magnitude in men (for NITDM, adjHR: 1.04; 95% CI: 0.77-1.39; for ITDM, adjHR: 1.46; 95% CI: 1.05-2.03; pint=0.016). CONCLUSIONS In a population treated with DES and antiplatelet therapy, the risk for CTE associated with DM seems to be greater in women and was independent of HPR.
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Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | | | - Giora Weisz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Shaare Zedek Medical Center, Jerusalem, Israel
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Michael J Rinaldi
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | | | - Timothy D Henry
- Cedars-Sinai Medical Center, Los Angeles, CA, USA; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - David A Cox
- Lehigh Valley Health Network, Allentown, PA, USA
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC, USA
| | | | - Bruce R Brodie
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
| | - Thomas D Stuckey
- LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Sorin J Brener
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, USA
| | - M Ozgu Ozan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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Regensteiner JG, Golden S, Huebschmann AG, Barrett-Connor E, Chang AY, Chyun D, Fox CS, Kim C, Mehta N, Reckelhoff JF, Reusch JEB, Rexrode KM, Sumner AE, Welty FK, Wenger NK, Anton B. Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2015; 132:2424-47. [PMID: 26644329 DOI: 10.1161/cir.0000000000000343] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Rost K, Hsieh YP, Xu S, Harman J. Gender differences in hospitalization after emergency room visits for depressive symptoms. J Womens Health (Larchmt) 2011; 20:719-24. [PMID: 21417934 DOI: 10.1089/jwh.2010.2396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER). METHODS We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey. RESULTS ER visits by depressed women have only 0.82 the odds of hospitalization (95% confidence interval [CI] 0.70-0.96, p=0.02) in models adjusted for sociodemographic, clinical, and system covariates. Sensitivity analyses demonstrate gender differences in visits by patients with no injury but not in visits by patients with self-inflicted injury. CONCLUSIONS These findings suggest that admission decisions after ER visits are not responsible for the increased risk of hospitalization previously reported in depressed women, as ER visits by women with depressive symptoms actually have lower odds of hospitalization than visits by men. We encourage further research to explore the causes and consequences of this practice pattern to move toward rational delivery systems committed to providing comparable treatment to clinically comparable individuals regardless of gender.
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Affiliation(s)
- Kathryn Rost
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.
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Saab FA, Steg PG, Avezum A, López-Sendón J, Anderson FA, Huang W, Eagle KA. Can an elderly woman's heart be too strong? Increased mortality with high versus normal ejection fraction after an acute coronary syndrome. The Global Registry of Acute Coronary Events. Am Heart J 2010; 160:849-54. [PMID: 21095271 DOI: 10.1016/j.ahj.2010.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 07/13/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in women. We sought to validate previous clinical experience in which we have observed that elderly women with a very high left ventricular ejection fraction (LVEF) are at increased risk of death compared with elderly women with acute coronary syndromes with a normal LVEF. METHODS Data from 5,127 elderly female patients (age >65 years) enrolled in the Global Registry of Acute Coronary Events were collected. Patients were divided into 3 groups based on their LVEF: group I had a low ejection fraction (<55%), group II had a normal ejection fraction (55%-65%), and group III had a high ejection fraction (>65%). χ² test and multiple logistic regression analysis were performed. The main outcome measures were death in-hospital and death, stroke, rehospitalization, and myocardial infarction at 6-month follow-up. RESULTS Hospital mortality was 12% in group I. Patients in group III were more likely to die in-hospital than those in group II (P = .003). Multivariable logistic regression showed that high ejection fraction was an independent predictor of hospital death (odds ratio [OR] 2.5, 95% CI [CI] 1.2-5.2, P = .01), 6-month death (OR 2.0, 95% CI 1.1-3.4, P = .01), and cardiac arrest/ventricular fibrillation (OR 2.5, 95% CI 1.2-5.0, P = .01) compared with the normal ejection fraction group. CONCLUSIONS Having a very high LVEF (> 65%) is associated with worse survival and higher rates of sudden cardiac death than an LVEF considered to be in the reference range.
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Affiliation(s)
- Fadi A Saab
- Department of Internal Medicine, Tufts University School of Medicine-Baystate Medical Center, Springfield, MA, USA.
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Martirosyan L, Voorham J, Haaijer-Ruskamp FM, Braspenning J, Wolffenbuttel BHR, Denig P. A systematic literature review: prescribing indicators related to type 2 diabetes mellitus and cardiovascular risk management. Pharmacoepidemiol Drug Saf 2010; 19:319-34. [PMID: 19960483 DOI: 10.1002/pds.1894] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Valid prescribing indicators (PI) are needed for reliable assessment of prescribing quality. The purpose of this study is to describe the validity of existing PI for type 2 diabetes mellitus and cardiovascular risk management. METHODS We conducted a systematic literature search for studies describing the development and assessment of relevant PIs between January 1990 and January 2009. We grouped identified PI as drug- or disease-oriented, and according to the aspects of prescribing addressed and the additional clinical information included. We reviewed the clinimetric characteristics of the different types of PI. RESULTS We identified 59 documents describing the clinimetrics of 16 types of PI covering relevant prescribing aspects, including first-choice treatment, safety issues, dosing, costs, sufficient and timely treatment. We identified three types of drug-oriented, and five types of disease-oriented PI with proven face and content validity as well as operational feasibility in different settings. PI focusing on treatment modifications were the only indicators that showed concurrent validity. Several solutions were proposed for dealing with case-mix and sample size problems, but their actual effect on PI scores was insufficiently assessed. Predictive validity of individual PI is not yet known. CONCLUSION We identified a range of existing PI that are valid for internal quality assessment as they are evidence-based, accepted by professionals, and reliable. For external use, problems of patient case-mix and sample size per PI should be better addressed. Further research is needed for selecting indicators that predict clinical outcomes.
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Affiliation(s)
- Liana Martirosyan
- Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, the Netherlands.
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Effects of gender and depression on oral medication adherence in persons with type 2 diabetes mellitus. ACTA ACUST UNITED AC 2007; 4:205-13. [DOI: 10.1016/s1550-8579(07)80041-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2007] [Indexed: 11/24/2022]
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Chou AF, Wong L, Weisman CS, Chan S, Bierman AS, Correa-de-Araujo R, Scholle SH. Gender disparities in cardiovascular disease care among commercial and medicare managed care plans. Womens Health Issues 2007; 17:139-49. [PMID: 17481918 DOI: 10.1016/j.whi.2007.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 03/22/2007] [Accepted: 03/22/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender disparities in cardiovascular care have been documented in studies of patients, but little is known about whether these disparities persist among managed health care plans. This study examined 1) the feasibility of gender-stratified quality of care reporting by commercial and Medicare health plans; 2) possible gender differences in performance on prevention and treatment of cardiovascular disease in US health plans; and 3) factors that may contribute to disparities as well as potential opportunities for closing the disparity gap. METHODS We evaluated plan-level performance on Healthcare Effectiveness Data and Information Set (HEDIS) measures using a national sample of commercial health plans that voluntarily reported gender-stratified data and for all Medicare plans with valid member-level data that allowed the computation of gender-stratified performance data. Key informant interviews were conducted with a subset of commercial plans. Participating commercial plans in this study tended to be larger and higher performing than other plans who routinely report on HEDIS performance. RESULTS Nearly all Medicare and commercial plans had sufficient numbers of eligible members to allow for stable reporting of gender-stratified performance rates for diabetes and hypertension, but fewer commercial plans were able to report gender-stratified data on measures where eligibility was based on recent cardiac events. Over half of participating commercial plans showed a disparity of >/=5% in favor of men for cholesterol control measures among persons with diabetes and persons with a recent cardiovascular procedure or heart attack, whereas no commercial plans showed such disparities in favor of women. These gender differences favoring men were even larger for Medicare plans, and disparities were not linked to health plan performance or region. CONCLUSIONS AND DISCUSSION Eliminating gender disparities in selected cardiovascular disease preventive quality of care measures has the potential to reduce major cardiac events including death by 4,785-10,170 per year among persons enrolled in US health plans. Health plans should be encouraged to collect and monitor quality of care data for cardiovascular disease for men and women separately as a focus for quality improvement.
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Affiliation(s)
- Ann F Chou
- Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma, 801 NE 13th Street, Oklahoma City, OK 73120, USA.
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Fremont AM, Correa-de-Araujo R, Hayes SN. Gender Disparities in Managed Care. Womens Health Issues 2007; 17:116-9. [PMID: 17512754 DOI: 10.1016/j.whi.2007.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 04/12/2007] [Indexed: 11/30/2022]
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Nau DP, Ellis JJ, Kline-Rogers EM, Mallya U, Eagle KA, Erickson SR. Gender and perceived severity of cardiac disease: evidence that women are "tougher". Am J Med 2005; 118:1256-61. [PMID: 16271910 DOI: 10.1016/j.amjmed.2005.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 08/03/2005] [Accepted: 08/03/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients' beliefs about their disease may affect their willingness to engage in preventive health behaviors. We sought to determine whether men and women with acute coronary syndrome differ in their perceptions of the severity of cardiac-related illness while controlling for the clinical severity of their condition. METHODS All patients with acute coronary syndrome discharged from a university hospital during a 3-year period were mailed a questionnaire, and medical records were abstracted. The questionnaire assessed perceived severity of cardiac-related illness (5-point scale from "very mild" to "very severe"), symptom frequency, type of acute coronary syndrome event, number of medications, Duke Activity Status Index (DASI), time since most recent cardiac event, Charlson Comorbidity Index, and demographic information. A logistic regression model was constructed with perceived severity of heart disease as the dependent variable. Gender was the key independent variable while controlling for the other patient and disease variables. RESULTS The 490 respondents (1217 surveys sent, 40.3% response rate) included 348 men and 142 women who were similar with regard to race and type of acute coronary syndrome event experienced. Women were older, less educated, had a lower DASI score, had more symptoms, and were taking more medications. However, they perceived their cardiac disease as being no more severe than the men. The significant predictors in the regression model of perceived severity included gender, DASI, number of symptoms, type of acute coronary syndrome event, and comorbidity. Female gender was associated with lower perceived severity (odds ratio 0.30-0.80). CONCLUSIONS Women rate their cardiac disease as less severe than do men when controlling for other measures of cardiac disease severity.
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Affiliation(s)
- David P Nau
- College of Pharmacy, Cardiology, University of Michigan, Ann Arbor, Mich 48109-1065, USA
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Jha AK, Perlin JB, Steinman MA, Peabody JW, Ayanian JZ. Quality of ambulatory care for women and men in the Veterans Affairs Health Care System. J Gen Intern Med 2005; 20:762-5. [PMID: 16050889 PMCID: PMC1490181 DOI: 10.1111/j.1525-1497.2005.0160.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory care is less well understood. OBJECTIVE To study gender differences in quality of care for patients receiving primary care in the Veterans Affairs (VA) Health Care System. DESIGN Cross-sectional samples of VA enrollees during fiscal years 1999 to 2000. PARTICIPANTS Samples of 6,442 to 86,405 men and women treated at VA facilities for whom at least 1 of 9 quality measures was available. MEASUREMENTS Appropriate general preventive services (pneumococcal vaccination, influenza vaccination, colorectal cancer screening), and specific services for diabetes (annual hemoglobin A1c [HbA1c] testing, good glycemic control, annual diabetic eye exam), hypertension (good blood pressure control), or prior myocardial infarction (use of beta-blockers or aspirin). RESULTS In adjusted analyses, there were no substantial gender differences in rates of appropriate care. For women compared with men, the adjusted relative risk for appropriate care ranged from 0.96 for blood pressure control (95% confidence interval: 0.93 to 0.99; P=.02) to 1.05 for HbA1c< or =8.0% (95% confidence interval: 1.03 to 1.07; P<.01). Analyses stratified by age demonstrated equivalent care between men and women in 9 of the 14 subgroups evaluated. CONCLUSIONS In this large national health care system that predominantly serves men, the quality of ambulatory care is equivalent for women and men on numerous measures.
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Affiliation(s)
- Ashish K Jha
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
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Katon WJ, Simon G, Russo J, Von Korff M, Lin EHB, Ludman E, Ciechanowski P, Bush T. Quality of Depression Care in a Population-Based Sample of Patients With Diabetes and Major Depression. Med Care 2004; 42:1222-9. [PMID: 15550802 DOI: 10.1097/00005650-200412000-00009] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Major depression occurs in approximately 11% to 15% of patients with diabetes and is associated with poor glycemic control and adverse medical outcomes. This study examined the rates and predictors of recognition of depression among primary care patients with diabetes and comorbid major depression and the quality of depression care provided during a 12-month period. METHODS This study used automated utilization, pharmacy, and laboratory data from a health maintenance organization to describe the rate of recognition of depression and quality of care provided for patients with major depression and diabetes in the 12-month period before diagnosis. Major depression was diagnosed based on the Patient Health Questionnaire (PHQ-9) that was included in a mail survey sent to 9063 patients on the Group Health diabetes registry from 9 primary care clinics. RESULTS Approximately 51% of patients with major depression and diabetes were recognized as depressed by the health care system. Women were more likely to be recognized (odds ratio [OR] 1.58, 95% confidence interval [CI 1.26-1.97]), as were those with dysthymia (OR 3.44, 95% CI 2.08-5.72), panic attacks (OR 1.55, 95% CI 1.19-2.19), patients with more than 7 primary care visits (OR 1.42, 95% CI 1.06-1.91) and patients reporting poor health (OR 1.62, 95% CI 1.04-2.53). Of the 51% of patients with major depression who were recognized, 43% received 1 or more antidepressant prescriptions but only 6.7% received 4 or more psychotherapy sessions during a 12-month period. DISCUSSION There were large gaps in both recognition and quality of depression care provided to patients with major depression and diabetes within a health maintenance organization system.
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Affiliation(s)
- Wayne J Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
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Katon W, von Korff M, Ciechanowski P, Russo J, Lin E, Simon G, Ludman E, Walker E, Bush T, Young B. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care 2004; 27:914-20. [PMID: 15047648 DOI: 10.2337/diacare.27.4.914] [Citation(s) in RCA: 279] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The goal of this study was to determine the behavioral and clinical characteristics of diabetes that are associated with depression after controlling for potentially confounding variables. RESEARCH DESIGN AND METHODS A population-based mail survey was sent to patients with diabetes from nine primary care clinics of a health maintenance organization. The Patient Health Questionnaire was used to diagnose depression, and automated diagnostic, pharmacy, and laboratory data were used to measure diabetes treatment intensity, HbA(1c) levels, and diabetes complications. RESULTS Independent factors that were associated with a significantly higher likelihood of meeting criteria for major depression included younger age, female sex, less education, being unmarried, BMI > or = >30 kg/m(2), smoking, higher nondiabetic medical comorbidity, higher numbers of diabetes complications in men, treatment with insulin, and higher HbA(1c) levels in patients <65 years of age. Independent factors associated with a significantly higher likelihood of meeting criteria for minor depression included younger age, less education, non-Caucasian status, BMI > or = 30 kg/m(2), smoking, longer duration of diabetes, and a higher number of complications in older (> or = 65 years) patients. CONCLUSIONS Smoking and obesity were associated with a higher likelihood of meeting criteria for major and minor depression. Diabetes complications and elevated HbA(1c) were associated with major depression among demographic subgroups: complications among men and HbA(1c) among individuals <65 years of age. Older patients with a higher number of complications had an increased likelihood of minor depression.
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Affiliation(s)
- Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
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Hayes SN, Weisman CS, Clark A. The Jacobs Institute of Women's Health report on the prevention of heart disease in women: findings and recommendations from the “Women and Heart Disease: Putting Prevention into Primary Care” Conference. Womens Health Issues 2003; 13:115-21. [PMID: 14509973 DOI: 10.1016/s1049-3867(03)00055-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Shannon N Hayes
- Women's Heart Clinic, Mayo Clinic, Rochester, Minnesota, USA
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