title: Physician knowledge levels and barriers to coronary risk prevention in women: survey results from the Women and Heart Disease Physician Education Initiative.
abstract: BACKGROUND
  Few studies have examined whether physician knowledge, attitudes, or practice patterns might contribute to gender disparities in the primary prevention of coronary heart disease (CHD), including among physicians caring for the largest number of reproductive-age women, obstetricians and gynecologists (OB/GYNs). We sought to identify barriers affecting the provision of recommended coronary risk factor therapies in women.
  
  
  METHODS
  We surveyed internists and OB/GYNs who attended Grand Rounds presentations developed for the New York State Women and Heart Disease Physician Education Initiative. This program was designed to improve screening and management of coronary risk factors in women. Attendees were asked to complete a 7-minute questionnaire.
  
  
  RESULTS
  The mean age of the 529 respondents was 40.3 years (standard deviation = 12.3), 75.1% were internists (n=378), and 42.7% (n=226) were women. Physicians correctly responded to 71.5% of the 13 questions assessing knowledge of coronary risk prevention (range, 4-13). Almost one third of internists and half of the OB/GYNs did not know that tobacco use was the leading cause of myocardial infarction in young women. For patients who smoked tobacco, only two thirds of internists and 55.4% of OB/GYNs reported suggesting a quit date (p=.007). After controlling for covariates, physicians who did not perceive time as a barrier were more likely to discuss smoking cessation (odds ratio=1.7 [1.1-2.7]).
  
  
  CONCLUSIONS
  Among the internists and OB/GYNs surveyed, time was perceived as a barrier to implementing risk prevention. These physicians also underestimated the impact of tobacco use as a risk factor for CHD in young women. To lessen gender disparities in CHD prevention, both specialties need time-efficient educational programs that reflect specialty differences.
authors.affiliation: Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, USA. barnhart@aecom.yu.edu
authors.forename: Janice
authors.initials: J
authors.lastname: Barnhart
authors.forename: Vivian
authors.initials: V
authors.lastname: Lewis
authors.forename: Jan Laws
authors.initials: JL
authors.lastname: Houghton
authors.forename: Pamela
authors.initials: P
authors.lastname: Charney
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003144:Communication Barriers; D003327:Coronary Disease / Q000175:diagnosis / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000592:standards; D010819:Physician's Role; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000706:statistics & numerical data; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology