Identification of low-value practices susceptible to gender bias in primary care setting

Abstract

Background Data on overuse of diagnostic and therapeutic resources underline their contribution to the decline in healthcare quality. The application of “Do Not Do” recommendations, in interaction with gender biases in primary care, remains to be fully understood. Therefore, this study aims to identify which low-value practices (LVPs) causing adverse events are susceptible to be applied in primary care setting with different frequency between men and women. Methods A consensus study was conducted between November 1, 2021, and July 4, 2022, in the primary care setting of the Valencian Community, Spain. Thirty-three of the 61 (54.1%) health professionals from clinical and research settings invited, completed the questionnaire. Participants were recruited by snowball sampling through two scientific societies, meeting specific inclusion criteria: over 10 years of professional experience and a minimum of 7 years focused on health studies from a gender perspective. An initial round using a questionnaire comprising 40 LVPs to assess consensus on their frequency in primary care, potential to cause serious adverse events, and different frequency between men and women possibly due to gender bias. A second round-questionnaire was administered to confirm the final selection of LVPs. Results This study identified nineteen LVPs potentially linked to serious adverse events with varying frequencies between men and women in primary care. Among the most gender-biased and harmful LVPs were the use of benzodiazepines for insomnia, delirium, and agitation in the elderly, and the use of hypnotics without a previous etiological diagnosis. Conclusions Identifying specific practices with potential gender biases, mainly in mental health for the elderly, contributes to healthcare promotion and bridges the gap in gender inequalities. Trial registration NCT05233852, registered on 10 February 2022.

Gender Disparities in Adverse Events Resulting From Low-Value Practices in Family Practice in Spain: A Retrospective Cohort Study

“…This tool, previously used in the SOBRINA study [ 8 ], was based on recommendations by Rosenberg et al [ 29 ]. The LVPs considered in this study were agreed in a previous study [ 30 ] ( Table 1 ). An online consensus technique involving 33 health professionals from family medicine, cardiology, intensive care, and geriatrics was conducted to reach a consensus on LVPs considering three aspects: 1) if it was still a relatively frequent LVP in primary care; 2) its frequency of application was different between men and women, with a probable association with sex or gender; and 3) if the LVP could cause a severe adverse event in the patient.…”

“…The study sample was stratified by age group and sex, considering the visit frequencies recorded in the National Health System’s primary care information system for 2018. Study participants were divided into three age groups: 18–59 years, 60–74 years, and >75 years, based on reference ages from prior studies [ 30 ]. A simple random sampling method with k = 5 was used to select the medical records of patients attended in the past 3 years.…”