AHRQ: Good news, bad news on gender discrepancies:
Although there are signs of improvement in some conditions, differences in the quality of health care provided to men and women continue to persist, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHQ).
The good news is that:
- In 2004, about as many women with Medicare (85%) received recommended care in the hospital after a heart attack as male Medicare patients (86%). As recently as 2002, only 79% of female Medicare patients received the recommended treatment after a heart attack, compared to 81% of male Medicare patients. Heart disease is the leading cause of death among both women and men.
- Women were more likely than men to have a usual source of ongoing health care in 2004 (90% compared with 83%). Across all income level groups and for most racial and ethnic groups, women reported having a usual source of ongoing care more often than men. A usual source of care is associated with lower costs and improved health outcomes.
However, there is bad news:
- Women were more likely than men to be hospitalized for high blood pressure in 2003 — 56 vs. 38 per 100,000 population. Hospitalization for high blood pressure can usually be avoided if patients have good quality primary care.
- Women age 50 and older were less likely than men to receive recommended colorectal cancer screening — 50% percent compared with 54% percent in 2003.
- There are disparities among women by race and ethnicity. For example, although only half of all white women are screened for colorectal cancer at age 50 or older, among Hispanic and black women the rates are even lower — 38% and 44%, respectively.
- Only 71% percent of American Indian-Alaska Native, 76% of black, and about 78% of Hispanic women start prenatal care in the first three months of pregnancy, compared with 86% of white women.
These data were derived from the "2006 National Healthcare Quality Report" and the "2006 National Healthcare Disparities Report," which measure the quality of health care across America in four areas — effectiveness of health care, patient safety, timeliness of care, and patient centeredness.
Phone-based therapy eases depression
When people receive brief telephone-based psychotherapy soon after starting on antidepressant medication, strong positive effects may continue 18 months after their first session. So concludes a group health study in the April Journal of Consulting and Clinical Psychology, which followed close to 400 patients.
Long-term positive effects of initially adding phone-based therapy included improvements in patients' symptoms of depression and satisfaction with their care. At 18 months, 77% of those who got phone-based therapy (but only 63% of those receiving regular care) reported their depression was "much" or "very much" improved. Those who received phone-based therapy were slightly better at taking their antidepressant medication as recommended, but that did not account for most of their improvement. And effects were stronger for patients with moderate to severe depression than for those with mild depression.
As is usual in clinical practice, the patients' primary care doctors diagnosed their depression and prescribed their antidepressants. Half of the patients also received eight sessions of telephone psychotherapy during the first six months, then two to four "booster" sessions in the second six months as well as medication follow-up and support from master's-level therapists.
The patients and therapists never met face to face, only over the phone. Therapists followed a structured protocol for psychotherapy. They encouraged the patients to identify and counter their negative thoughts (cognitive behavioral therapy), pursue activities they had enjoyed in the past (behavioral activation), and develop a plan to care for themselves.
Few of the patients who received phone-based therapy — even fewer than those who did not receive it — sought in-person therapy.
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