1
|
Haynes D, Pampari A, Topham C, Schwarzenberger K, Heath M, Zou J, Greiling TM. Patient Experience Surveys Reveal Gender-Biased Descriptions of Their Care Providers. J Med Syst 2021; 45:90. [PMID: 34468879 DOI: 10.1007/s10916-021-01766-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Patient experience surveys (PES) are collected by healthcare systems as a surrogate marker of quality and published unedited online for the purpose of transparency, but these surveys may reflect gender biases directed toward healthcare providers. This retrospective study evaluated PES at a single university hospital between July 2016 and June 2018. Surveys were stratified by overall provider rating and self-identified provider gender. Adjectives from free-text survey comments were extracted using natural language processing techniques and applied to a statistical machine learning model to identify descriptors predictive of provider gender. 109,994 surveys were collected, 17,395 contained free-text comments describing 687 unique providers. The mean overall rating between male (8.84, n = 8558) and female (8.80, n = 8837) providers did not differ (p = 0.149). However, highly-rated male providers were more often described for their agentic qualities using adjectives such as "informative," "forthright," "superior," and "utmost" (OR 1.48, p < 0.01)-whereas highly-rated female providers were more often described by their communal qualities through adjectives such as "empathetic," "sweet," "warm," "attentive," and "approachable" (OR 2.11, p < 0.0001). PES may contain gender stereotypes, raising questions about their impact on physicians and their validity as a quality metric which must be balanced with the need for unedited transparency. Future prospective studies are needed to further characterize this trend across geographically and racially diverse healthcare providers.
Collapse
Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Anusri Pampari
- Department of Biomedical Data Science, Stanford University, 350 Serra Mall, Room 258, Stanford, CA, 94305, USA
| | - Christina Topham
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Kathryn Schwarzenberger
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Michael Heath
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - James Zou
- Department of Biomedical Data Science, Stanford University, 350 Serra Mall, Room 258, Stanford, CA, 94305, USA.
| | - Teri M Greiling
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA.
| |
Collapse
|
2
|
Baharudin N, Ahmad Roslan AM, Mohamed Yassin MS, Ramli AS, Zainal Abidin ANI, Sahar NH, Din NSS, Ibrahim IS, Abd Rahim SNH, Rosli NA. Gender disparity in the prescription of secondary prevention medications in a Malaysian primary care clinic. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:37-44. [PMID: 34386162 PMCID: PMC8346747 DOI: 10.51866/oa1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it. METHODS A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs. RESULTS Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin II receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 - 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 - 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 - 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 - 6.370). CONCLUSION Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.
Collapse
Affiliation(s)
- Noorhida Baharudin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia,
| | - Ahmad Muslim Ahmad Roslan
- MBBS (RCMP), Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Mohamed Syarif Mohamed Yassin
- MBBS (Monash), FRACGP (Australia) Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Anis Safura Ramli
- MBBS (Newcastle, UK), MRCGP (UK), Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Aiza Nur Izdihar Zainal Abidin
- MD (Volgograd, Russia), Department of Primary Care, Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Nurul Hidayatullaila Sahar
- MB. BCh. BAO (TCD, Ireland), Department of Primary Care, Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Nor Shazatul Salwana Din
- MD (UKM), Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Izyana Syazlin Ibrahim
- MD (USU, Indonesia), Department of Primary Care, Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Siti Nur Hidayah Abd Rahim
- MBBS (IMU), Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - Nur Athirah Rosli
- MBBS (UiTM), Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| |
Collapse
|
3
|
Dewi PEN, Thavorncharoensap M. Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The early use of statin with intensive regimen has been recommended by the recent guidelines as the prevention of acute coronary syndrome (ACS) related events among the high-risk patients. Meanwhile, the inconsistent statin utilization for targeted patient in current practice is still an issue.
AIM: This study aims to review the utilization rate of statin among patients with ACS.
METHODS: A systematic search of relevant studies published between inceptions to June 2020 was conducted in PubMed. Patients and intervention domains were used to build up the searching formula. A study was eligible for inclusion if it was an original study of patients with ACS and it examined the utilization of statin. The risk of bias was assessed using Axis and NOS checklist.
RESULTS: Among the 49 eligible studies, 38 were cohort studies while the others were cross-sectional studies. The utilization rate of statin at hospital admission ranged from 16% to 61% while 25% to 75% during the hospitalization. Of the total studies, 35 studies reported the statin rate at discharge ranging from 58% to 99%. Almost all studies revealed the reduction of statin utilization rate along the follow-up period. The number of statins prescribed was found to be lower among female and elderly patients.
CONCLUSION: Despite the established benefits of statin among patients with ACS, our study revealed that statin was underutilized for secondary prevention after ACS. To improve patients’ clinical outcomes with ACS, efforts should be made to increase optimal treatment and compliance with a statin.
Collapse
|
4
|
de Oliveira Costa J, Bruno C, Schaffer AL, Raichand S, Karanges EA, Pearson SA. The changing face of Australian data reforms: impact on pharmacoepidemiology research. Int J Popul Data Sci 2021; 6:1418. [PMID: 34007904 PMCID: PMC8107783 DOI: 10.23889/ijpds.v6i1.1418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE A wealth of data is generated through Australia's universal health care arrangements. However, use of these data has been hampered by different federal and state legislation, privacy concerns and challenges in linking data across jurisdictions. A series of data reforms have been touted to increase population health research capacity in Australia, including pharmacoepidemiology research. Here we catalogued research leveraging Australia's Pharmaceutical Benefits Scheme (PBS) data (2014-2018) and discussed these outputs in the context of previously implemented and new data reforms. METHODS We conducted a systematic review of population-based studies using PBS dispensing claims. Independent reviewers screened abstracts of 4,996 articles and 310 full-text manuscripts. We characterised publications according to study population, analytical approach, data sources used, aims and medicines focus. RESULTS We identified 180 studies; 133 used individual-level data, 70 linked PBS dispensing claims with other health data (66 across jurisdictions). Studies using individual-level data focussed on Australians receiving government benefits (87 studies) rather than all PBS-eligible persons. 63 studies examined clinician or patient practices and 33 examined exposure-outcome relationships (27 evaluated medicines safety, 6 evaluated effectiveness). Medicines acting on the nervous and cardiovascular system account for the greatest volume of PBS medicines dispensed and were the most commonly studied (67 and 40 studies, respectively). Antineoplastic and immunomodulating agents account for approximately one third of PBS expenditure but represented only 10% of studies in this review. CONCLUSIONS The studies in this review represent more than a third of all population-based pharmacoepidemiology research published in the last three decades in Australia. Recent data reforms have contributed to this escalating output. However, studies are concentrated among specific subpopulations and medicines classes, and there remains a limited understanding of population benefits and harms derived from medicines use. The current draft Data Availability and Transparency legislation should further bolster efforts in population health research.
Collapse
Affiliation(s)
| | - Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Andrea L Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Smriti Raichand
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Emily A Karanges
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| |
Collapse
|
5
|
Ma TT, Wong ICK, Whittlesea C, Mackenzie IS, Man KKC, Lau W, Brauer R, Wei L. Initial cardiovascular treatment patterns during the first 90 days following an incident cardiovascular event. Br J Clin Pharmacol 2020; 87:1043-1055. [PMID: 32643191 DOI: 10.1111/bcp.14463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to investigate the initial cardiovascular prescription patterns in patients after their first cardiovascular events, and to identify factors associated with cardiovascular polypharmacy. METHODS This was a cross-sectional study including patients aged ≥ 45 years with the first record of coronary heart disease (CHD) or stroke between 2007 and 2016 using The Health Improvement Network database. This study investigated the patterns of cardiovascular drugs prescribed during the first 90 days after the first cardiovascular events. Logistic regression was used to examine the association between patients' baseline characteristics and cardiovascular polypharmacy (≥5 cardiovascular drugs). RESULTS A total of 121,600 (59,843 CHD and 61,757 stroke) patients were included in the study. The mean age was 69.5 ± 11.9 years. The proportion of patients who were prescribed 0-1, 2-3, 4-5 drugs and ≥6 drugs were 11.0%, 29.8%, 38.6% and 20.5%, respectively. Factors associated with cardiovascular polypharmacy were sex (female: OR 0.74, 95% CI 0.72-0.76 vs male), age (75-84 years old: OR 0.50, 0.47-0.53 vs 45-54 years old), smoking status (current smoking: OR 1.29, 1.15-1.24 vs never), body mass index (obesity: OR 1.38, 1.34-1.43 vs normal), deprivation status (most deprived: OR 1.09, 1.04-1.14 vs least deprived) and Charlson comorbidity index (index ≥5: OR 1.25, 1.16-1.35 vs index 0). CONCLUSION Multiple cardiovascular drugs treatment was common in patients with CVD in the UK. High-risk factors of CVD were also associated with cardiovascular polypharmacy. Further studies are warranted to assess the impact of cardiovascular polypharmacy and its interaction on CVD recurrence and mortality.
Collapse
Affiliation(s)
- Tian-Tian Ma
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Isla S Mackenzie
- Medicines Monitoring Unit (MEMO Research) and Hypertension Research Centre, University of Dundee, Dundee, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Wallis Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| |
Collapse
|
6
|
Cardioprotective medication adherence in Western Australians in the first year after myocardial infarction: restricted cubic spline analysis of adherence-outcome relationships. Sci Rep 2020; 10:4315. [PMID: 32152400 PMCID: PMC7062740 DOI: 10.1038/s41598-020-60799-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/10/2020] [Indexed: 11/30/2022] Open
Abstract
Adherence to cardioprotective medications following myocardial infarction (MI) is commonly assessed using a binary threshold of 80%. We investigated the relationship between medication adherence as a continuous measure and outcomes in MI survivors using restricted cubic splines (RCS). We identified all patients aged ≥65 years hospitalised for MI from 2003–2008 who survived one-year post-discharge (n = 5938). Adherence to statins, beta-blockers, renin angiotensin system inhibitors (RASI) and clopidogrel was calculated using proportion of days covered to one-year post-discharge (landmark date). Outcomes were 1-year all-cause death and major adverse cardiac events (MACE) after the landmark date. Adherence-outcome associations were estimated from RCS Cox regression models. RCS analyses indicated decreasing risk for both outcomes above 60% adherence for statins, RASI and clopidogrel, with each 10% increase in adherence associated with a 13.9%, 12.1% and 18.0% decrease respectively in adjusted risk of all-cause death (all p < 0.02). Similar results were observed for MACE (all p < 0.03). Beta-blockers had no effect on outcomes at any level of adherence. In MI survivors, increasing adherence to statins, RASI, and clopidogrel, but not beta blockers, is associated with a decreasing risk of death/MACE with no adherence threshold beyond 60%. Medication adherence should be considered as a continuous measure in outcomes analyses.
Collapse
|
7
|
Temporal Trends in Sudden Cardiac Death From 1997 to 2010: A Data Linkage Study. Heart Lung Circ 2017; 26:808-816. [PMID: 28190759 DOI: 10.1016/j.hlc.2016.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Community-wide trends data for sudden cardiac death (SCD) are scarce, unlike widely reported declines in cardiovascular disease (CVD) mortality. Using administrative data, we aimed to examine population-level trends in SCD, stratified by sex, age and prior CVD hospitalisation. METHODS Person-linked mortality and hospital morbidity data were used to identify SCD and determine hospitalisation and comorbidity using a 10-year hospitalisation lookback period. Log-linear Poisson regression was used to calculate annual rate changes and rate ratios. RESULTS In Western Australia, 7160 SCD cases were identified from 1997 to 2010 with males comprising 69%. Overall age-standardised SCD rates decreased by 17% in men and 31% in women from 1997-2001 to 2007-2010. The annual rate reduction was higher in women than men (-4.0%/year versus -2.3%/year; p=0.0039). Significant reductions were observed for 55-69 year-old and 70-84 year-old men and women but not for the 35-54 year-olds. The overall relative risk comparing men to women increased slightly from 2.4 in 1997 to 3.0 in 2010 (trend p=0.0039) but differed across age groups. The relative risk declined in 35-54 year-olds from 5.1 to 3.2 whereas it increased from 2.9 to 3.9 in 55-69 year-olds and 1.9 to 2.3 in 70-84 year-olds. Declining trends in SCD rates were observed in those with and without prior CVD and were similar to CVD mortality trends (-4.9%/year in men and -5.5%/year in women). CONCLUSIONS Trends in rates of SCD fell in middle to older aged men and women, with and without CVD, and mirrored the fall in fatal CVD. Limited improvement in 35-54 year-olds requires further investigation.
Collapse
|