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May 17, 2007:
Women with heart disease and diabetes are less
likely to receive several types of routine
outpatient medical care than do men, a study
conducted in the United States has revealed.
The study has been titled Improving the quality of
care for cardiovascular disease: Using national
managed care performance data to investigate
gender differences in HEDIS measures related to
heart disease.
It analysed data collected from a national sample
of 46 commercially managed care plans and 148
Medicare plans across 11 HEDIS measures of care
for cardiovascular conditions and diabetes.
The results, controlled for other factors such as
age, income and ethnicity, showed equal or better
outcomes for women on most dimensions of care –
with the notable exception of cholesterol control,
where significant disparities existed between men
and women.
All the patients in the study, conducted by the
Rand Corporation, had either private insurance or
were enrolled in US Medicare managed-care plans
and had been diagnosed with heart disease and/or
diabetes and had visited health providers to
receive care.
The study is being published in the May-June 2007
edition of the journal Women’s Health Issues.
It found that, among people enrolled in commercial
health plans, women were significantly less likely
than men to receive the care evaluated in six of
the 11 measures. Also, women enrolled in the
Medicare plans were less likely to receive the
care evaluated in four of the 11 measures.
Researchers of the Rand Corporation studied over
50,000 men and women and examined 11 different
screening tests, treatments or measurements of
health status shown to be important to all people
diagnosed with heart disease or diabetes.
It was found that women are significantly less
likely than men to have their LDL cholesterol (the
‘bad’ cholesterol) controlled to recommended
levels. Elevated LDL cholesterol is an important
modifiable risk factor for cardiovascular disease,
the leading single cause of death for both women
and men.
Women must know their risk for heart disease and
how to manage it, says Dr Ileana L Piña,
spokesperson for National Go Red For Women and
professor of medicine at Case Western Reserve
University. The study findings show an opportunity
to improve patient care for women and a reason to
encourage women to consider seriously how to
manage their risk factors, such as elevated
cholesterol especially the LDL portion of
cholesterol.
The American Heart Association’s website
GoRedForWomen.org offers resources and tools for
women to understand their cardiovascular risk and
how to manage it.
The study also examined investigated disparities
in care owing to race and income level, and found
significant gaps in care. For example, based on
the study findings, 55.4% of white men with recent
cardiac events who were in commercial plans met
the recommended lipid control level. For other
groups, the comparable figures were 46.2% for
white women, 44.8% for African-American men, and
34.2% for African American women.
Similar disparities were found based on income
level.
These findings suggest that women and their health
care providers underestimate risk for high
cholesterol and heart disease, leading to poorer
cholesterol control among women. The high cost of
medications may also be a secondary factor.
In February 2007, the American Heart Association
had published updated women’s treatment guidelines
in Circulation: Journal of the American Heart
Association. The guidelines included more
aggressive recommendations for high-risk women,
including reducing LDL cholesterol to less than 70
mg/dL in very-high risk women with heart disease.
BY OUR PHARMA CORRESPONDENT
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