The European Journal of Public Health Advance Access originally published online on July 28, 2005
The European Journal of Public Health 2005 15(6):634-639; doi:10.1093/eurpub/cki050
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Health Inequalities |
Exploring gender and socioeconomic differences in treatment of coronary heart disease
Kristiina Manderbacka** Outcomes and Equity Research Group, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland
Correspondence: K. Manderbacka, DSocSc, Senior Researcher, Outcomes and Equity Research Group, National Research and Development Centre for Welfare and Health (STAKES), PO Box 220, 00531 Helsinki, Finland, tel: +358 9 3967 2078, fax: +358 9 3967 2485, e-mail: kristiina.manderbacka{at}stakes.fi
Background: Earlier studies on gender and socioeconomic differences in the treatment of coronary heart disease have focused mainly on structural features of the health-care system on the one hand and on coronary patients' psychosocial characteristics on the other. The aim of this exploratory qualitative study was to trace key points in the pathways of treatment where patients' experience varies and which can contribute to gender and socioeconomic differences in treatment. Methods: The data consist of 30 interviews among persons diagnosed with or suspected to have coronary heart disease in the Health 2000, a representative cross-sectional interview and health examination survey. Purposive sampling was used to ensure variation in gender, socioeconomic status and disease severity. The data were analysed using qualitative content analysis. Results: Gender and socioeconomic differences were found in two key points in the pathways of treatment: doctor–patient interaction and the organization of primary care. The three features commonly distinguished in doctor–patient interaction, i.e. treatment decision-making, information exchange and interpersonal relationship, were all found to be relevant. A second key point was organization of primary care in terms of both access to examinations and care, and continuity of care. Conclusions: These results should sensitize us to gender and socioeconomic differences in coronary patients' problems in access to and continuity of care, as well as to potential problem areas in doctor–patient interaction.
Keywords: coronary heart disease, equity, health services research, patient perspective
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