title: The association of patient-physician gender concordance with cardiovascular disease risk factor control and treatment in diabetes.
abstract: BACKGROUND
  Gender concordance between patients and their physicians is related to prevention screening and other quality indicators. Research suggests female physicians may place greater emphasis on preventive care than male physicians; however, little is known about whether physician gender and patient-physician gender concordance are associated with cardiovascular disease (CVD) risk factor levels and treatment. Our objective was to examine associations between patient gender, physician gender, and their interaction with CVD risk factor control, medication adherence, and treatment intensification in diabetes.
  
  
  METHODS
  In this study, 157,458 Kaiser Permanente Northern California adult diabetes patients with a primary care physician (PCP) were assessed for above target levels of hemoglobin A1c (HbA1c) (>or=8%), low-density lipoprotein cholesterol (LDL-C) (>or=100 mg/dL), and systolic blood pressure (SBP>or=130 mm Hg) in 2005. Medication adherence and appropriate CVD treatment intensification were assessed using pharmacy data. Probit models assessed the adjusted marginal effects of patient gender, PCP gender, and their interaction on control, adherence, and intensification.
  
  
  RESULTS
  Female patients had lower adjusted rates of LDL-C (46% vs. 55%, p<0.001) and SBP control (52% vs. 60%, p<0.001) than males. Female patients of female PCPs had the highest adjusted rates of HbA1c control of the four patient-physician gender dyads (70% vs. 66%-68%, p<0.05). Male patients were more likely than female patients to receive treatment intensification for high SBP (60% vs. 57%, p<0.001). Female PCPs were more likely than their male counterparts to intensify therapy for hyperlipidemia and hypertension.
  
  
  CONCLUSIONS
  Patient and physician gender and gender concordance are modestly associated with CVD risk factor control and treatment in diabetes. Further understanding of these differences could lead to improved CVD outcomes for women.
authors.affiliation: Division of Research, Kaiser Permanente Medical Care Program, Northern California, Oakland, California 94612, USA. Julie.A.Schmittdiel@kp.org
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Ana
authors.initials: A
authors.lastname: Traylor
authors.forename: Connie S
authors.initials: CS
authors.lastname: Uratsu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
authors.forename: Assiamira
authors.initials: A
authors.lastname: Ferrara
authors.forename: Usha
authors.initials: U
authors.lastname: Subramanian
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010822:Physicians, Women / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012737:Sex Factors; D016896:Treatment Outcome; D035502:Trust
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents