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Sex Differences in Patient and Provider Response to Elevated Low-Density Lipoprotein Cholesterol

      Abstract

      Background

      Despite American Heart Association recommendations of diet/lifestyle modification and statin therapy to achieve low-density lipoprotein cholesterol (LDL) control, women are less likely than men to be screened and achieve treatment goals. This study determined whether the provider and patient response to electronic medical record (EMR) notification of an elevated LDL varied by patient sex in veterans.

      Methods

      Provider responses to EMR clinical reminders for an elevated LDL (≥100 mg/dL) were assessed in men (n = 40,738) and women (n = 1,025) veterans with ischemic heart disease or diabetes between October 2008 and September 2009. Responses were classified into four types: 1) Whether the patient refused medication, 2) the provider ordered or adjusted medication, 3) treatment was deferred/medications were not changed, or 4) medications were contraindicated. Logistic regression with generalized estimating equations was used to compare clinical reminder responses between men and women patients.

      Findings

      Providers were less likely to order or adjust medications for women (adjusted odds ratio [OR], 0.75; 95% CI, 0.63, 0.88) and women were more likely than men to refuse medication (adjusted OR, 1.71; 95% CI, 1.34, 2.17). These associations were not modified by degree of LDL elevation or use of lipid-lowering medications.

      Conclusion

      These results indicate that poorer cholesterol control in at risk women is likely a consequence of both provider and patient factors.
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      Biography

      Sally G. Haskell, MD, is the Deputy Chief Consultant for Clinical Operations, Women's Health Services, Veterans Health Administration, and an Associate Professor of Medicine Yale School of Medicine. She is a Co-Principal investigator of the VA HSR&D funded Women Veteran's Cohort Study.

      Biography

      Harini Bathulapalli, MPH, is a biostatistician at the VA Connecticut Healthcare System, where she conducts analysis for the HSR&D funded Women Veterans Cohort Study and the Veteran's Aging Cohort Study.

      Biography

      Tan Pham, MPH, is Graduate Student in Epidemiology from the University of Massachusetts.

      Biography

      Dr. Joseph Goulet, PhD, is Assistant Professor of Psychiatry at Yale University, and is director of the methodology and biostatistics core of the VA HSR&D–funded Pain Research, Informatics, Medical Comorbidities, and Education Center (PRIME) at West Haven, Connecticut.

      Biography

      Melissa Skanderson, MSW, is the chief programmer for the VA HSR&D funded Women Veterans Cohort Study and an expert in National VA data procurement and processing.

      Biography

      Mary Driscoll, PhD, is an Advanced Fellow in Women's Health at the VA Connecticut Healthcare System.

      Biography

      Cynthia Brandt, MD, MPH, is a Professor of Emergency Medicine at Yale University, Yale Center for Medical Informatics, and a VA Staff Physician. She Co-Directs the West Haven VA postdoctoral training program in Medical Informatics and is Co-PI of the VA HSR&D funded Women Veteran's Cohort Study.

      Biography

      James Dziura, PhD, is an Associate Professor of Emergency Medicine at Yale University and the Deputy Director of the Yale Center for Analytical Sciences.