Dataset Information

Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort.

ABSTRACT:

Objective

This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years.

Design

Cohort-based cross-sectional study.

Setting

Danish general practice.

Subjects

Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 years).

Main outcome measures

The sum of cohort members' face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993-1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993-1997), when information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire.

Results

Women had on average 4.1 and men 2.8 consultations per year. In a crude model, women had 47% higher rate of GP visits than men (incidence rate ratio: 1.47; 95% Confidence Interval: 1.45-1.50), which remained unchanged after adjustment for lifestyle, socio-demographic and medical factors, but attenuated to 18% (1.18; 1.13-1.24) after adjustment for female factors (gravidity and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59-1.67), mental illness (1.63; 1.61-1.66), diabetes (1.56; 1.47-1.65), angina pectoris (1.28; 1.21-1.34), and unemployed persons (1.19; 1.18-1.21) had highest rates of GP visits.

Conclusions

Gravidity and HT use explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key points Female gender remained a dominant determinant of GP utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP. Strongest determinants for GP use among Danish adults aged 50-65 years were the presence of medical conditions (somatic and mental) and unemployment, while lifestyle factors (e.g., body mass index, alcohol consumption and smoking) had minor effect.

SUBMITTER: Jorgensen JT

PROVIDER: S-EPMC5036013 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort.

Jørgensen Jeanette Therming JT Andersen John Sahl JS Tjønneland Anne A Andersen Zorana Jovanovic ZJ

Scandinavian journal of primary health care 20160715 3

<h4>Objective</h4>This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years.<h4>Design</h4>Cohort-based cross-sectional study.<h4>Setting</h4>Danish general practice.<h4>Subjects</h4>Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 years).<h4>Main outcome measures</h4>The sum of cohort members' face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993-199 ...[more]

PMID: 27421064

Similar Datasets

Project description:BackgroundAttempts to manage the COVID-19 pandemic have involved a massive flow of guidelines and information to health professionals on how to reorganize clinical work and handle patients with COVID-19. The aim of this paper is to investigate how Danish general practitioners (GPs) made sense of and worked with guidelines and associated information on COVID-19 in the first months of the pandemic.MethodsWe conducted qualitative interviews with 13 GPs in the beginning of the pandemic and again approximately three months later. Between the two interviews, they wrote daily notes for 20 days. Interviews were audio-recorded and transcribed, and the material was analyzed using thematic network analysis.ResultsThe interviewed GPs found the situation urgent and serious, and they spent a lot of time reading and working with COVID-19 related guidelines and associated information. Keeping up-to-date with and implementing guidelines was challenging due to the many sources of information and the constant guideline revisions. The GPs were able to assess patients' risk status but were challenged by the changing guidelines regarding this. The GPs found that deciding whether a COVID-19 patient needed to be admitted to hospital was relatively straightforward. An important final challenge was discrepancies between the government's public announcements regarding which patients could be tested for COVID-19, the guidelines provided to GPs, and the local testing capacities, which gave GPs extra work.ConclusionIn an urgent situation like the COVID-19 pandemic it is crucial to secure good communication between the government, health authorities, professional medical societies, and health professionals. Improved practices of collaboration between health authorities and professional societies could improve communication in future health crises and relieve GPs of some of the work involved in keeping up-to-date with information flows, constantly reviewing new guidelines, and dealing with communicative inconsistencies.

Project description:BACKGROUND:Ethnic minority groups from Asia and Africa living in Western countries have a higher prevalence of type 2 diabetes (T2DM) than the general population. We aimed to assess ethnic differences in diabetes care by gender. METHODS:Population-based, cross-sectional study identified 10,161 individuals with T2DM cared for by 282 General Practitioners (GP) in Norway. Ethnicity was based on country of birth. Multilevel regression models adjusted for individual and GP factors were applied to evaluate ethnic differences by gender. RESULTS:Diabetes was diagnosed at a younger mean age in all other ethnic groups compared with Westerners (men: 45.9-51.6?years vs. 56.4?years, women: 44.9-53.8?years vs. 59.1?years). Among Westerners mean age at diagnosis was 2.7?years higher in women compared with men, while no gender difference in age at diagnosis was found in any minority group. Daily smoking was most common among Eastern European, South Asian and Middle East/North African men. In both genders, we found no ethnic differences in processes of care (GPs' measurement of HbA1c, blood pressure, LDL-cholesterol, creatinine). The proportion who achieved the HbA1c treatment target was higher in Westerners (men: 62.3%; women: 66.1%), than in ethnic minorities (men 48.2%; women 53.5%). Compared with Western men, the odds ratio (OR) for achieving the target was 0.45 (95% CI 0.27 to 0.73) in Eastern European; 0.67 (0.51 to 0.87) in South Asian and 0.62 (0.43 to 0.88) in Middle Eastern/North African men. Compared with Western women, OR was 0.49 (0.28 to 0.87) in Eastern European and 0.64 (0.47 to 0.86) South Asian women. Compared with Westerners, the blood pressure target was more often achieved in South Asians and Middle Easterners/North Africans in both genders. Small ethnic differences in achieving the LDL-cholesterol treatment target by gender were found. CONCLUSION:Diabetes was diagnosed at a considerably earlier age in both minority men and minority women compared with Westerners. Several minority groups had worse glycaemic control compared with Westerners in both genders, which implies that it is necessary to improve glucose lowering treatment for the minority groups. Smoking cessation advice should particularly be offered to men in most minority groups.

Project description:ObjectivesAre multiple missed appointments in general practice associated with increased use of hospital services and missingness from hospital care? This novel study explores this in a population representative sample for the first time.Design, setting, participantsA large, retrospective cohort (n = 824,374) of patient records from a nationally representative sample of GP practices, Scotland, 2013-2016. Requested data were extracted by a Trusted Third Party for the NHS, anonymised and linked to a unique patient ID, in the NHS Safehaven for analysis using established NHS Scotland linkage. We calculated the per-patient number of GP missed appointments from individual appointments and investigated the likelihood of hospital appointment or admission outcomes using a negative binomial model offset by number of GP appointments made. These models also controlled for age, sex, Scottish Index of Multiple Deprivation (SIMD) and number of long- term conditions (LTCs).Main outcome measuresHospital attendance: Outpatient clinic attendances; hospital admissions; Emergency Department (ED) attendances. Hospital missingness: 'Did not attend' (DNAs) outpatient clinic appointments, 'irregular discharges' from admissions, and 'left before care completed' ED care episodes.ResultsAttendance: Patients in the high missed GP appointment (HMA) category were higher users of outpatient services (rate ratio (RR) 1.90, 95% confidence intervals (CI) 1.88-1.93) compared to those who missed none (NMA) with a much higher attendance risk at mental health services (RR 4.56, 95% CI 4.31-4.83). HMA patients were more likely to be admitted to hospital; general admissions (RR 1.67, 95% CI 1.65-1.68), maternity (RR 1.24, 95% CI 1.20-1.28) and mental health (RR 1.23, 95% CI 1.15-1.31), compared to NMA patients. Missing GP appointments was not associated with ED attendance; (RR 1.00, CI 0.99-1.01). Missingness: HMA patients were at greater risk of missing outpatient appointments (RR 1.62, 95% CI 1.60-1.64) than NMA patients; with a much higher risk of non-attendance at mental health services (RR 7.83, 95% CI 7.35-8.35). Patients were more likely to leave hospital before their care plan was completed-taking 'irregular discharges' (RR 4.56, 95% CI 4.31-4.81). HMA patients were no more at risk of leaving emergency departments 'without care being completed' (RR1.02, 95 CI 0.95-1.09).ConclusionsPatients who miss high numbers of GP appointments are higher users of outpatient and inpatient hospital care but not of emergency departments, signalling high treatment burden. The pattern of 'missingness' is consistent from primary care to hospital care: patients who have patterns of missing GP appointments have patterns of missing many outpatient appointments and are more likely to experience 'irregular discharge' from in-patient care. Missingness from outpatient mental health services is very high. Policymakers, health service planners and clinicians should consider the role and contribution of 'missingness' in health care to improving patient safety and care.

Project description:BackgroundAnaemia can be a pointer of underlying severe disease, including undiagnosed malignancy. Subsequent blood tests are essential to classify the anaemia into subtypes and to facilitate targeted diagnostic investigation to ensure timely diagnosis of underlying disease.ObjectiveWe aimed to describe and classify anaemia based on laboratory tests from patients with new-onset anaemia detected in general practice. An additional aim was to analyse associations between patient characteristics and unclassified anaemia (not classifiable according to an algorithm).DesignPopulation-based cross-sectional study.SettingDanish general practice.SubjectsA total of 62,731 patients (age: 40-90 years) with new-onset anaemia were identified in Danish laboratory information systems and nationwide registries, and data were obtained for 2014-2018.Main outcome measuresWe measured the proportion of patients classified into subtypes of anaemia based on blood tests requested by general practitioners within 31 days of the anaemia index date.ResultsOf the 62,731 patients with new-onset anaemia, we identified unclassified anaemia in 78.9% (95% confidence interval (CI): 77.3-80.5) of men and 65.1% (CI: 63.4-66.9) of women. The likelihood of unclassified anaemia increased with age, increasing comorbidity and decreasing severity of anaemia.ConclusionThe majority of patients with new-onset anaemia could not be classified through a simple algorithm due to missing blood tests, which highlights a potential missed opportunity for diagnosis. Standardised laboratory testing of patients with anaemia is warranted to ensure adequate follow-up and early detection of underlying severe disease.KEY POINTSAnaemia can be a sign of malignancy, and anaemia classification is an important step in the diagnosis of underlying disorders.The majority of patients with anaemia could not be classified according to a simple algorithm due to missing blood tests.Some patient characteristics were associated with a high risk of unclassified anaemia: high age, high comorbidity, and severe anaemia.Standardised laboratory testing in patients with anaemia is needed to inform targeted diagnostic investigation to ensure timely diagnosis.

Dataset Information

Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort.

Objective

Design

Setting

Subjects

Main outcome measures

Results

Conclusions

Publications

Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets