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The European Journal of Public Health Advance Access published online on July 28, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki050
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received February 10, 2004
Accepted August 31, 2004

Article

Exploring gender and socioeconomic differences in treatment of coronary heart disease

Kristiina Manderbacka 1*

1 Outcomes and Equity Research Group, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland

* To whom correspondence should be addressed.
Kristiina Manderbacka, E-mail: kristiina.manderbacka{at}stakes.fi


  Abstract

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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