BUENOS AIRES, Argentina — According to a Spanish study, several low-value medical indications or practices that are considered pointless, unnecessary and potentially more harmful are performed more often on women than men. Examples of such low-value practices include benzodiazepines for insomnia in people over 65, nonsteroidal anti-inflammatory drugs in people with hypertension or chronic kidney disease, antibiotics for acute bronchitis in patients without certain co-morbidities, and imaging tests for low back pain without another. warning sign before 6 weeks. The study was discussed at a patient safety meeting in Buenos Aires.
“There’s no gender difference that explains it, but rather gender factors,” said Joaquín José Mira Solves, PhD, a psychologist and professor at Miguel Hernández University in Elche, Spain. Medscape Spanish edition. “Differentiated treatment is given to patients because they are women, to whom more weakness or less capacity is attributed. It is part of a general culture, and the curious thing is that it does not depend on whether the medical professional is a man is or woman.” Mira is principal investigator of the Overgend Project, which aims to analyze primary care overtreatment from a gender perspective to reduce the number of women who suffer from side effects from unnecessary treatments.
The phenomenon sheds light on an under-appreciated extra dimension that should be taken into account in efforts to promote high-quality practices that do not endanger patients and reduce health system inefficiency.
At the meeting, which was held as part of the launch of the Argentine Observatory for Patient Safety, Mira shared the results of a recent Spanish retrospective cohort study he led. Researchers analyzed 2,557 electronic health records from adult and pediatric primary care patients of both sexes. The authors identified 1,859 actions (72.7%) in 1,307 patients on “don’t” recommendation lists, of which 1,507 were indicated by adult physicians.
Notably, recommendations to avoid certain treatments were ignored more often in adult female patients (583/1004) than in males (430/924), with a crude rate of 58.1% (95% CI, 55.0-61 .1) and adjusted to 49.4% (95% CI, 48.5-50.3) for the first and 46.5% (95% CI, 43.3-49.8) and 46, respectively, 5% (95% CI, 43.3-49.8) for the latter. For both percentages, the differences were statistically significant (p < .0001). There were no gender differences between children.
“This study has given rise to a new one, currently ongoing, targeting those who ‘don’t’ in which these differences due to gender are more outrageous,” said Mira, who argues that the approach to pain and emotional distress are two areas. where evidence suggests that overtreatment is especially higher in women.
In the published work, although no specific statistical analysis was performed to adjust for the larger number of women in the sample, there were large gender differences in the occurrence of various non-recommended practices or indications in the medical records. For example, when using benzodiazepines for insomnia in people over 65 years of age (68.9% in women, compared to 32.2% in men); at the start of treatment with paracetamol at a dose of 1 g (57.0% vs 43.0%); when prescribing nonsteroidal anti-inflammatory drugs in patients with hypertension, heart failure, chronic kidney disease, and liver cirrhosis (57.0% vs. 43.0%); in the indication of antibiotics for acute bronchitis in patients without chronic obstructive pulmonary disease, heart failure, diabetes, pneumonia, tonsillitis, bordetella infection or kidney disease or receiving active chemotherapy (60.7% vs 39.3%); or when prescribing lipid-lowering agents in patients over 75 years of age with no prior cardiovascular events (68.1% vs. 31.9%).
Preventable Side Effects
The inequality between men and women is even more concerning because women also seem to be more likely to suffer the ill effects of these unnecessary regulations or practices. In the study, the researchers documented 69 episodes of avoidable adverse events related to disregarding the counter-recommendations (5.3%), including 54 (5.1%) of 1,062 in adult patients, more frequently in patients over 65 years of age, and 15 ( 6.1%) of 245 in pediatric patients. Most incidents were considered minor transient physical injuries, without fatalities, although other consequences of overtreatment, such as psychological and financial consequences, were not considered.
Again, avoidable adverse events derived from indications not recommended in adults were more common in females (32/583) than males (22/430), with crude adjusted rates of 5.5% (95% CI, 3.6- 7.3) and 4.9% (95% CI, 4.4-5.5) for female adult patients and 5.1% (95% CI, 3.0-7.2) and 4, respectively 0% (95% CI, 3.4-4.7) for adult males, with a statistically significant difference for the adjusted rates (p = .047).
Commenting on the study, Karin Kopitowski, MD, a master’s degree in clinical effectiveness and chief of family medicine at the Italian Hospital in Buenos Aires, Argentina, described it as interesting, but added that nothing has been documented in the country and in the region on overtreatment-related gender bias. “It’s a nascent movement with very little alertness among health professionals and the general population,” she said Medscape.
The specialist, who also heads the research department of the University Institute of the Italian Hospital (IUHI), recalled that over-benefits are “the other side of the coin” of the sub-benefits, in which gender differences have been studied more. “For example, in the cardiovascular field, we’re less likely to get the diagnosis or catheterization in a timely manner.”
“Just like the character in the movie yentl, in which a Jewish woman takes on the appearance of a man to enter the synagogue and study the sacred texts, women must show the same symptoms as men with an acute myocardial infarction to be hospitalized and receive the correct diagnosis and treatment,” Public health physician Elisa Chilet Rosell of the Global Health Research Group of the Department of Public Health, History of Science and Gynecology at Miguel Hernández University, Elche, Spain, told Medscape. “In fact, Bernadine Healy, MD, coined the term ‘Yentl syndrome’.”
Why can women be overtreated in other pathologies? “It may be related to certain gender stereotypes, and a clear example may be the greater prescription in women than men of anxiolytics, sleeping pills and pills for mental health problems. Women’s emotional distress is medicalized by erroneous and cause-blind symptomatic therapeutic strategies, as described by feminist writer Betty Friedan,” Chilet said.
“The definition of pathologies such as depression is the product of cultural practices that define suffering, this definition depends on the context and the moment. Both this definition and the psychometric instruments to measure depression are influenced by the hegemonic constructions of femininity and masculinity in any Normative features of female behavior, such as crying or hypersensitivity, would be interpreted as symptoms of depression and would often omit cognitive or affective symptoms that are more common in males,” she added.
The Overgend project received a grant from the Prometheus program of the Ministry of Innovation, Universities, Science and Digital Society of the Regional Government of Valencia with the added participation of the ATENEA research group of the Fisabio Foundation, in Valencia, Spain . Chilet, Solves and Kopitowski have declared no material conflicts of interest.
Follow Matías A. Loewy from Medscape Spanish edition on Twitter @Mloewy.
This article was translated from the Spanish edition of Medscape.