By Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D.
This article was originally published in Women's Health Issues 2004;14:31-4. Copyright© 2004 by the Jacobs Institute of Women's Health.
Contents
Introduction
Research
Clinical Practice
Policy
Curriculum Development and Research Training
References
Introduction
Women's health has recently become a major
clinical field, as well as a relevant public issue
(Kasper, 2002). Providing health care to women is
complex and challenging, and requires the coordinated
effort of a multidisciplinary team of health care
professionals. To succeed in this effort health care
professionals need to practice good communication
skills, have access to evidence-based information and
be able to translate scientific evidence into their clinical
practice. As patients, women should have easy
access to the latest evidence-based information designed
to help them make the right decisions about
their care and the care of their family members.
Recently, there has been a significant increase in
representation of women in clinical trials (NIH, June 2003), including the Women's Health
Initiative. These trials have yielded abundant findings
with high clinical relevance to women (Cauley, et al.,
2003; Hays, et al., 2003; Manson, et al., 2003). Health
services research has also shown that although
women seek more medical care, use more health care
services, and spend more on medications than men
(Roe, McNamara, & Motheral, 2002), inequalities in
care still limit women's access to certain diagnostic
procedures and therapies proven to be effective for
specific conditions (Weisman, 1999; Bierman &
Clancy, 2001; Grady, Chaput, & Kristof, 2003). Much,
therefore, still needs to be done to improve access,
receipt, and quality of care for this priority population.
The challenge remains to go beyond research findings
to ensure that research is used to eliminate inequalities
in care and foster effective improvements in the health
care system and in the health and quality of life of
women of all ages.
Recently, the Women's Health Interest Group was
created at AcademyHealth. Its mission is
to foster the development of the field of women's
health services research to meet the needs of and
improve the quality and outcomes of care of women
across life span and for all women independent of
race, ethnicity, or socioeconomic position. (AcademyHealth)
Although improving health care requires a combined
effort of researchers, providers, and policymakers,
a special interest group such as this may play a
significant role. The diversity and commitment of
those involved in such a group create a unique networking
opportunity for the advancement of women's
health.
Interest group members (e.g., practitioners,
researchers, policymakers, trainees) may have different
backgrounds and work under diverse incentives,
but their work complements each other and ultimately,
they all share the same common goal of
improving quality of care for women. The dialogue
among group members should contribute to:
- Closing communication gaps.
- Identifying research priorities and joint efforts to promote curriculum development.
- Building on research skills.
- Redirecting research needs.
- Disseminating research findings.
- Developing implementation strategies.
- Informing and advocating for changes in policy to benefit women.
In summary,
the Women's Health Interest Group should be able to
address the following areas relevant to women's
health: research, clinical practice, policy, and curriculum
development and research training.
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Research
Over the past few years, the definition of women's
health has evolved beyond reproductive issues and
now targets all health concerns experienced by
women across lifespan and in the social context of
their lives (Weisman, 1997). Currently, an expanded
research agenda is being developed to address conditions
specific to women and those common to both
women and men. The new research includes identifying
health care disparities between women and men
and among female subpopulations as well as understanding
gender differences in disease manifestations
and response to therapy.
For example, researchers
have only recently clearly identified some of the
diagnostic and treatment needs of women with heart
disease. A systematic review of the literature supported
by the Agency for Healthcare Research and
Quality (AHRQ) and the National Institutes of Health
(NIH) Office of Research on Women's Health revealed
that the lack of studies on women limits the usefulness
of the research available on coronary heart disease
(Grady et al., 2003). Women with heart disease remain
less likely to receive proper management including
procedures and drug therapies (e.g., beta-blockers,
aspirin, ACE inhibitors) found to be effective in reducing
the risk of coronary heart disease events. They also
are less likely to be submitted to certain diagnostic
tests. In addition the diagnostic value of tests to
evaluate troponins, creatinine kinase, and myoglobin
in women is still unknown.
As we move in direction of a gender-based approach,
chronic diseases will continue to be the focus
of major research efforts in women's health. This trend
is given added impetus due to the fast growth of the
elderly population. A broad range of opportunities is
available for behavioral scientists and health services
researchers interested in better understanding certain
diseases and conditions, as well as the quality of care
and well-being of women (Baldwin, 2003; Davenport,
2001; Legato, 2003).
Defining quality in women's care and developing a
research agenda to measure women's quality of care
are critical to improving the health care and health
status of women and facilitating changes in policy
(Weisman, 2000). As health services researchers continue
to demonstrate issues with access, receipt, and
quality of care for women, research should also concentrate
on the development, implementation, and
evaluation of models of care delivery. These models
should:
- Optimize both preventive and therapeutic care for women of all ages.
- Provide women with the best care and the opportunity to be active and well-informed participants in the clinical decisionmaking process.
- Reduce and/or eliminate health care disparities.
Numerous studies have investigated key aspects of
comprehensive care for women. A study comparing
generalists to obstetricians and gynecologists who
simultaneously provided care to women revealed that
relying on generalists alone may result in substandard
preventive care for nonelderly women (Henderson,
Weisman, & Grason, 2002). When three types of plans
(managed care, fee for service with utilization control,
and traditional fee for service) were compared, managed
care plans provided women similar or better
access to care (Weisman & Henderson, 2001). Women
under managed care plans received more gender-specific
clinical prevention, but reported lower satisfaction
with this type of plan. Women's health clinical
centers have been shown to better integrate clinical
services with research and training on women's health
(Weisman & Squires, 2000). Furthermore, the delivery
of services in these centers was found to have reached
a more diverse population of women. Clinical care at
these centers provided significantly more screening
tests and counseling services and resulted in greater
patient satisfaction when compared to women in
benchmark samples (Anderson, et al., 2002). However,
further research is needed to identify models of care
that eliminate gaps and unnecessary health care visits
and integrate women's preferences into their care
plans.
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Clinical Practice
Gender-based studies may result in improvements in
morbidity and mortality and allow the development
of quality indicators and measures, which if implemented
as best practices may lead to decreases in
health care costs and elimination of inequalities in
care. As Legato (2003) states, "the most important task
is to convince the scientific, medical and lay public
that women are a source of invaluable information
that improves health of all patients." For example,
gender differences on widely used measures of quality
of primary and secondary prevention of cardiovascular
disease have been reported. These differences may
represent a major opportunity to improve health for
all and make reporting of gender-stratified objective
quality measures routine for health plans (Bird, et al., 2003). The
Women's Health Measurement Advisory Panel of the
National Council on Quality Assurance is expected to
make a major contribution in this area (Weisman,
2000). The panel is developing quality measures relevant
to health plans on top priority health conditions
for women (e.g., cardiovascular disease, diabetes, and
osteoporosis).
The integration of social and biological research is of
great help to clinicians and policymakers. This may
allow better understanding and facilitate proper management
of gender-specific and nonspecific health
issues (Bird & Ricker, 2002). Moreover, it is also crucial that health care professionals be culturally sensitive to
the needs of a diverse population. Health literacy of
patients and cultural competency of health care professionals,
particularly those directly involved in therapeutic
decisions, are interrelated and can exert significant
influence on health outcomes (Nunez &
Robertson, 2003).
Finally, identification and integration of factors associated
with variations in clinical care and/or performance
measures across comprehensive care for
women are critical. This information is needed to
develop quality improvement strategies including
those targeting reduction of health care disparities.
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Policy
Policy and coverage decisions are highly dependent
on evidence-based information. This ensures access to
new and innovative technologies and procedures that
can improve quality of health care and reduce disparities.
Policies targeting the basic needs of women are
in place, but require continuous review to ensure that
all women across life stages have access to reasonable
care that emphasizes health promotion and disease
prevention. As we move toward addressing the needs
of middle-aged and older women and their risks of
developing chronic conditions, it may be necessary to
establish new standards of care and develop new
policies (Baldwin, 2003). Policies also are needed to
ensure educational programs are funded to increase
awareness of chronic diseases and prevention strategies
that can reduce disease burden and improve
quality of life of women and the well-being of their
family members. As coverage policies change or are
expanded, the role of research becomes even more
important (Davenport, 2001). It is crucial, though, that
any new knowledge be accompanied by strategies that
can better assure translation of research findings to
policymakers (Bierman, 2003; Clancy, 2003).
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Curriculum Development and Research Training
Medical schools in the United States have improved
their women's health curriculum (Keitt, et al., 2003). The Office of Women's Health at
the Health Resources and Services Administration
successfully led an effort to ensure inclusion of women's
health in curricula of medical schools (Women's
Health in the Medical School Curriculum, 1996), dental schools
(Women's Health in the Dental School Curriculum, 1996), and baccalaureate
nursing schools (Women's Health in the Baccalaureate
Nursing School Curriculum, 2001). This effort has been extended
to schools of pharmacy and schools of public health.
Academic centers need to explore strategies to ensure
the inclusion of sex and gender analysis in scientific
research and the teaching of gender-based issues
(Legato, 2003).
Further efforts should seek adequate
faculty funding and training in women's health (Keitt
et al., 2003). Addressing this need, the National Institutes
of Health Office of Research on Women's Health
has a unique, innovative program that tackles career
development and the building of research skills in
women's health. AHRQ
also funds a career development grant awards program
for independent scientists or mentored clinical
scientists who want to develop skills in health services
research (www.ahrq.gov/fund/training/trainix.htm). Moreover, health care professionals
should be encouraged to take advantage of
the training opportunities the American Medical Association
provides to increase physician's knowledge
on health literacy and make them more culturally
competent (www.ama-assn.org).
We hope that the
members of the Women's Health Interest Group at the
AcademyHealth will enable us to keep abreast of
curriculum and training needs and foster continual
evolution of health care professionals in addressing
and meeting the health care needs of women.
Health services researchers are now challenged to
expand their research skills. It is no longer enough to
demonstrate the evidence, but as one plans a study, it
is necessary to have a vision for the next steps that will
assure knowledge transfer and implementation of
research findings. To promote this approach, AHRQ is
currently seeking to fund studies with a strategic
implementation component. Partnership is crucial,
and serves to facilitate effective communications to
policymakers and accelerate the adoption of research
findings (Clancy, 2003). By working together, the
members of the AcademyHealth Women's Health
Interest Group can significantly contribute to the
advancement of women's health services research by
addressing issues that will lead to improved health
care for women and also meet the needs of decision
and policymakers.
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Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., is a cardiovascular
pathologist trained at the National Heart,
Lung, and Blood Institute. As the Agency for Healthcare Research and Quality's Senior Advisor
on Women's Health, Dr. Correa oversees the development
of a national research agenda for women in
consultation with prominent members of the research
community, and other government agencies. Her
main areas of interest include gender-based medicine
particularly related to chronic diseases, medication
use outcomes and safety, and disparities in health care
for women.
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Internet Citation:
Correa-de-Araujo, R. A Wake-up Call to Advance Women's Health. Article originally published in Women's Health Issues 2004;14:31-4. Copyright© 2004 by the Jacobs Institute of Women's Health. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/wmwakeup.htm
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