Primary Health Care System
RESEARCH AND KNOWLEDGE TRANSFER

RESEARCH FELLOWSHIP REPORTS

An examination of gender equity in the processes of cardiovascular disease care in Canadian primary clinics
Investigators:

• Dr. Clare Liddy: C.T. Lamont Primary Health Care Research Centre, Bruy ère Research Institute, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada
• Kiyuri Naicker: Department of Family Medicine, University of Ottawa, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada
  Dr. Simone Dahrouge: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada;
• Jatinderpreet Singh: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada;
• Dr. William Hogg: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyère St. Ottawa, Ontario, K1N 5C8, Canada
  

Background:
This study sought to determine whether patient sex differences exist in relation to adherence to process of care guidelines for cardiovascular disease within primary care practices in Ontario, with the goal of identifying specific gaps for improvement of equity in care delivered within the primary care system.

Methods:
This study was a secondary analysis undertaken as part of a larger quality improvement initiative known as the Improved Delivery of Cardiovascular Care initiative (IDOCC). Data on 4.931 patients from 84 primary care practices in Eastern Ontario was collected through chart abstraction. Guideline to adherence measures were collected across nine areas of care related to CVD care. A clustered logistic regression analysis was performed, controlling for age, practice remuneration structure and urbanicity, with sex as the main predictor of guideline adherence.

Results:
Inequities in delivery of care were observed for both women and men. Overall, women were significantly less likely to be prescribed lipid lowering medication for dyslipidemia (OR = 1.54) have, their lipid profiles taken (OR = 1.17), and to be prescribed ASA following stroke (OR = 1.56) than men. Women with PVD were significantly less likely to be prescribed ACE inhibitors and/or angiotensin receptor blockers (OR = 1.74) and lipid lowering medications (OR = 1.95) or ASA (OR = 1.59). They were more likely to have two blood pressure measurements taken. Male patients with diabetes were less likely to be prescribed glycemic control medication than women (OR = 0.84) and hypertensive men were less likely to have two blood pressure readings taken (OR = 0.79).

Conclusions:
Disparities do still exist in the quality of cardiovascular disease care in Canadian primary care practices by patient sex, independent of disease diagnosis and detection, which generally tend to favour men. This research has been completed.

For more information please contact:
Kiyuri Naicker knaicker@uottawa.ca

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