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Family Practice, Vol 15, 404-410, Copyright © 1998 by World Organization of Family Doctors

ORIGINAL CLINICAL RESEARCH

Gender differences in general practice consultations: methodological challenges in epidemiological research

K Malterud and I Okkes
Department of Public Health and Primary Health Care, University of Bergen, Norway.

BACKGROUND: Women consult their GP more often than men do. The distribution of complaints and diagnoses are different for women and men patients. Although several findings on gender differentials on mortality and health care consumption are rather consistent across studies, detailed findings and subsequent conclusions diverge in several important fields. OBJECTIVES: Our aim was to explore methodological aspects of research on gender differences in general practice. METHODS: We reviewed empirical studies within this field, aiming to identify methodological and interpretative intricacies which deserve special attention in epidemiological research on GP consultations. RESULTS AND CONCLUSIONS: We found that descriptive and explanatory levels of research are frequently confused. Simple questions, answers and explanations are commonly raised for complex issues within a poorly defined theoretical explanatory framework. There is a need to assess relevant approaches for various purposes, and to develop more uniform conceptual terms. Findings from one level are often transferred to another, incompatible level. Epidemiological issues must be considered, especially matters related to denominator level and standardization/confounders-not in order to decide which level represents 'reality', but to clarify the consequences of different measures for different research questions. The contents of the core variables and the potentials for bias should be discussed in order to provide a sound basis for future explanatory studies.
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