Inequalities in health care between men and women have been described extensively with regard to access to diagnostic and therapeutic procedures. These inequalities affect coronary heart disease care. Although survival rates differ for men and women following a myocardial infarction, this alone does not fully explain inequity in access to health services, especially diagnostic and treatment procedures, for infarct survivors.
A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients (41% female) admitted to the Acute Cardiac Unit, Nottingham.
Women expressed more dissatisfaction than men overall (p<0.05) and appeared to have more physical needs. Women were more likely to complain about transport, which influenced their access to healthcare facilities (p<0.001), to be concerned about getting help with cleaning (p<0.01), and to request information about rehabilitation services, potential limitations on their daily activities, and nutrition and diet (p<0.05).
Women had lower health-related quality of life scores in all the HRQL variables, which was significant in EQ-5D (usual activities, and pain/discomfort), Seattle angina questionnaire (angina stability), and both components of the Short Form-12.
This survey was the first attempt to apply a needs assessment tool combined with quality of life assessment for cardiac patients to identify potential gender disparities. Women reported greater health needs and greater dissatisfaction with current health services and had worse HRQL. Recognition of gender disparities in health needs and HRQL would clarify areas for improvement in healthcare services, and these might allow a better quality of life for infarct survivors.
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