An evaluation of gender equity in different models of primary care practices in Ontario

Dahrouge, Simone; Hogg, William; Tuna, Meltem; Russell, Grant; Devlin, Rose Anne; Tugwell, Peter; Kristjansson, Elisabeth
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p151
Academic Journal
Background: The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods: This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart ions (n = 4,108). Results: Health service delivery measures were comparable in women and men, with differences ⩽ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions: The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued.


Related Articles

  • WHO calls for return to primary care to help ailing health systems. Zarocostas, John // BMJ: British Medical Journal (International Edition);10/18/2008, Vol. 337 Issue 7675, p897 

    The article reports that the World Health Organization (WHO) has called for countries to return to primary health in an effort to help health systems provide better performance and equity. WHO's report for 2008, "Primary Health Care: Now More Than Ever," explains how universal coverage reforms...

  • The future of primary care medicine. Bolhack, Scott Matthew // Inside Tucson Business;12/2/96 Supplement Executive Wellne, Vol. 6 Issue 36, p6 

    Discusses changes shaping primary care medicine in the United States. Overlapping roles assumed by a primary care physician; Three primary-care specialties in medicine; Impact of health care reform efforts on primary care; Tip on choosing a primary-care physician; Prediction of a rationing of...

  • Networking the future. Billingham, Kate // Primary Health Care;Apr2002, Vol. 12 Issue 3, p14 

    Argues that the growth of primary care trusts (PCT) will give more opportunities for nurses, midwives and health visitors in primary care in Great Britain. Priorities of the investment and reform program set up by the National Health Service; Organizational levels for PCT services; Input of...

  • Future of primary care: Part 2. Gerson, William T. // Infectious Diseases in Children;Jul2013, Vol. 26 Issue 7, p14 

    The article presents the second part of a series in which the author discusses the need for primary care general pediatricians to continue to be the premier model of care and the lead advocate for children's health in the face of changes in the healthcare industry.

  • Your views: Retirement is beckoning.  // GP: General Practitioner;10/14/2013, p10 

    A letter to the editor is presented in response to the article "Hunt Warns Primary Care Faces Very Big Change" in the September 30, 2013 issue.

  • The Ljubljana Charter on Reforming Health Care.  // BMJ: British Medical Journal (International Edition);6/29/96, Vol. 312 Issue 7047, p1664 

    Presents the text of the Ljubljana Charter on Reforming Health Care in Europe drafted by the World Health Organization in Ljubljana, Slovenia. Preamble; Fundamental principles; Principles for managing change.

  • Joint effort.  // Presidents & Prime Ministers;Sep/Oct98, Vol. 7 Issue 5, p29 

    Focuses on the joint effort of the World Health Organization (WHO) and the Ministry of Health of the Republic of Moldova to improve the health of its people. Cause of the deteriorating health status of the country's population; Information on the comprehensive national health policy and health...

  • Afghanistan: A nation beset by war. Gebreel, Ashour Omar // World Health;Nov/Dec96, Vol. 49 Issue 6, p14 

    Focuses on the Afghanistan's Ministry of Health and the World Health Organizations (WHO) plans to rehabilitate and develop Afghanistan's health services after the war. WHO, the United Nations and nongovernmental organization's formation of regional primary health care network in Afghanistan;...

  • Who is WHO’s expert committee? Welch, Craig // BMJ: British Medical Journal;8/23/2014, Vol. 349 Issue 7972, p19 

    A letter to the editor is presented in response to the article about the importance of the standard of applications and the clarity of reporting of decisions by the World Health Organization expert committee in medicines by C. Barbui and M. Purgato in the July 31, 2014 issue.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics