Gender sensitivity among general practitioners: Results of a training programme

Contains fulltext : 70167.pdf (publisher's version ) (Open Access)BACKGROUND: Gender differences contribute to patients' health and illness. However in current healthcare practices attention to gender differences is still underdeveloped. Recognizing these differences and taking them into account can improve the quality of care. In this study we aimed to investigate whether GPs' gender sensitivity can be stimulated by a training programme. The focus was on three diseases: angina pectoris, depression and urinary incontinence. METHODS: This study had a quantitative, explorative and descriptive design. By means of a training programme 18 GPs were trained to focus on gender-sensitive recommendations for the three diseases. With standardised registration forms, data were collected during a 6-month period. During the registration period, the GPs were visited by the study team to discuss the process of data collection. RESULTS: The GPs filled in registration forms for 100 patients: 39 with angina pectoris (31 women and 8 men), 40 with depression (26 women and 14 men), and 21 with urinary incontinence (20 women and 1 man). The results show that gender sensitivity can be stimulated among trained professionals. The combination of the training programme, clear and practical recommendations, daily discussion of relevant cases between the GP couples, feedback and support during registration by the study team probably contributed to the outcome. CONCLUSION: GPs' gender sensitivity was stimulated by the training programme and the supporting visits. Ideally, structural attention could be realised by embedding gender issues in existing organisational structures of general practices

Urinary incontinence in the elderly: attitudes and experiences of general practitioners. A focus group study.

Contains fulltext : 50429.pdf (publisher's version ) (Open Access)OBJECTIVE: To assess general practitioners' (GPs') attitudes to urinary incontinence in elderly patients and their experiences in the application of the Dutch College of General Practitioners' guideline in daily practice. DESIGN: Two existed groups of six GPs working in villages and seven GPs working in urban practices. METHOD: Two focus-group discussions with recording of discussions and transcription. Transcripts were analysed by two independent researchers. RESULTS: During the discussions three main themes of attitudes came forward: (1) therapeutic nihilism of GPs and low motivation of patients, (2): GPs experienced lack of time because of difficulties in explaining the therapy and because of impaired mobility of older patients, (3) because of the complexity of the problem and co-morbidity, GPs as well as patients were reluctant to treat the UI. The most remarkable findings in the application of the guideline were: (1) because of the barriers mentioned above, physical examination did not take place in spite of GPs' conviction as to the benefit of it; (2) GPs' knowledge of treatment options in the elderly with UI is substandard. CONCLUSION: Several patient (comorbidity, impaired mobility, low motivation, and acceptance of the problem) and GP factors (therapeutic nihilism, lack of time and knowledge) interfere with good management of UI in the elderly

"It can always happen": the impact of urinary incontinence on elderly men and women.

Contains fulltext : 50950.pdf (publisher's version ) (Open Access

The importance of gender in health problems

Contains fulltext : 70745.pdf (publisher's version ) (Closed access)OBJECTIVE: To investigate gender differences in health problems in general practice. METHODS: We performed a study using data from the Continuous Morbidity Registration (CMR) Nijmegen. To study the distribution by gender we analysed overall morbidity per 1000 patients years over a period of 10 years. Secondly we calculated the influence of gender by diagnostic rubric. For each diagnosis in the rubric of musculoskeletal disorders, we calculated incidence and sex ratio related to socio econonomic status (SES). We did the same concerning the referral rates for cardiovascular disease (CVD). RESULTS: Women had significantly more health problems than men, most striking in the age group 25-44 years, due to screening and reproductive health problems. Concerning gender differences related to SES in muskulo skeletal disorders we found the lower the SES the more prevalent is osteoarthritis of the knee in women. The sex ratios in CVD showed men as leading sufferers. Decreasing SES resulted in increasing incidence of CVD and a lower referral rate to the cardiologist in women. CONCLUSION: Sex differences appear in the prevalence of health problems, risk factors and access to medical care. They also can influence the course of diseases. Health problems in men and women also vary according to socio-economic status, meaning that gender is strongly intertwined as risk factor with socio-economic status, ethnicity, and age

Changes in the pattern of service utilisation and health problems of women, men and various age groups following a destructive disaster: a matched cohort study with a pre-disaster assessment.

Contains fulltext : 69779.pdf (publisher's version ) (Open Access)OBJECTIVES: Female gender and young age are known risk factors for psychological morbidity after a disaster, but this conclusion is based on studies without a pre-disaster assessment. The aim of this study in family practice was to investigate if these supposed risk factors would still occur in a study design with a pre-disaster measurement. METHODS: A matched cohort study with pre-disaster (one year) and post-disaster (five years) data. Community controls (N = 3164) were matched with affected residents (N = 3164) on gender, age and socioeconomic status. Main outcome measures were utilization rates measured by family practice attendances and psychological, musculoskeletal and digestive health problems as registered by the family practitioner using the International Classification of Primary Care (ICPC). RESULTS: Affected residents of female and male gender and in five age groups all showed increases in utilization rates in the first post-disaster year and in psychological problems when compared to their pre-disaster baseline levels. The increases showed no statistically significant changes, however, between women and men and between all age groups. CONCLUSION: Gender and age did not appear to be disaster-related risk factors in this study in family practice with a pre-disaster base line assessment, a comparison group and using existing registries. Family practitioners should not focus specifically on these risk groups