番茄社区

WASHINGTON -- Patients seen by a female gastroenterologist went on to use fewer healthcare resources in the 2 years after their initial visit than if they were seen by a male gastroenterologist, according to a retrospective study from Canada.

Using population-based data from the past two decades for the province of Ontario, researchers found a lower incidence of emergency department (ED) visits, hospitalizations, and primary care visits for patients seen by female gastroenterologists:

• ED visits: incidence ratio rate (IRR) 0.88 (95% CI 0.88-0.89)
• Hospitalizations: IRR 0.80 (95% CI 0.80-0.81)
• Primary care visits: IRR 0.93 (95% CI 0.93-0.93)

The association remained significant when stratified by female or male patients, but the effect was more pronounced in female patients, especially when it came to the reduction in inpatient hospitalizations (IRR 0.77, 95% CI 0.76-0.77), reported Laura Targownik, MD, of Mount Sinai Hospital at the University of Toronto, in a poster presentation at the annual Digestive Disease Week conference.

The thinking behind the study, she told 番茄社区, was that if patients are not getting good healthcare during their initial consult, they may spend more time at the ED or in extra clinic visits.

"There are significant differences in the healthcare systems between the United States and Canada, but the behavioral and cultural norms between the U.S. and Canada are similar. Although there are differences such as in time spent with patients that could be different across borders," said Targownik.

Despite the fact that female patients are more likely to seek care from a gastroenterologist, less than a third of gastroenterologists are women, according to background information in the poster. Having a female physician has been associated with better surgical results, lower hospital readmission rates, lower mortality, and higher satisfaction with care, yet no prior studies have looked at the effect of a gastroenterologist's sex on patients' healthcare utilization.

"We really can't tell from this data if the patients are getting better care, in terms of morbidity and mortality outcomes," noted co-investigator Jordana Herblum, MD, also of the University of Toronto. "We just know from this study that patients are less likely to access other healthcare resources if they were seen first by a woman gastroenterologist."

Targownik said the findings are hypothesis generating. "We see a difference," she said, "but there could be dozens of reasons why there is this difference. The challenge is to do the studies to find out what is causing the differences, and this is in the spirit of how can we make everyone do better with their patients."

For their study, the researchers examined 2,719,077 gastroenterology (GI) consultations from 2002 to 2020 in the Ontario Health ICES database. Overall, 15% were performed by female gastroenterologists and 85% by male gastroenterologists.

Female patients comprised 55% of the consults overall, including 65% of those performed by female gastroenterologists and 53% of those performed by male gastroenterologists. Regardless of the treating physician, female patients tended to have more ED and primary care visits, but fewer hospitalizations compared with male patients.

Regardless of patient sex, the incidence rate for those under the care of a female versus male gastroenterologist were as follows:

• ED visits: 42.7 vs 48.3 per hundred person-years, respectively
• Hospitalizations: 12.1 vs 15.1 per hundred person-years
• Primary care visits: 526.3 vs 566.7 per hundred person-years

Notably, the lower incidence associated with female gastroenterologists for these three types of healthcare visits was seen across the different conditions examined -- pre-existing inflammatory bowel disease (IBD), incidence IBD, or other GI diagnoses.

"More information on the types and severity of clinical conditions would be helpful to explain differences in care," said Shazia Siddique, MD, of the University of Pennsylvania in Philadelphia, who was not involved in the study.

"Since the most common gastrointestinal disease in our clinic is irritable bowel syndrome, and we have prior data to show that a strong physician-patient relationship is predictive of improvement in irritable bowel syndrome symptoms (which would thereby reduce office visits and emergency room visits), it is possible that female gastroenterologists in this study are building stronger relationships, leading to lower healthcare utilization," Siddique told 番茄社区. "The authors need to provide more data on the distribution of irritable bowel syndrome and other conditions within these cohorts in order to determine if that is a likely explanation."

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