Hospitals, physicians fight for women's equity in healthcare research, delivery

After a report earlier this year revealed clinical studies that overlook gender difference can leave women at a disadvantage when it comes to heart disease, depression, Alzheimer's and lung cancer, hospitals and physicians around the country are working to improve equity in healthcare research and delivery.

In September, the National Institues of Health (NIH) announced it invested $10.1 million in supplemental funding to bolster the research of 82 grantees to explore the effects of sex in preclinical and clinical studies. 

"This funding strategy demonstrates our commitment to moving the needle toward better health for all Americans, while helping grow our knowledge base for both sexes and building research infrastructure to aid future studies," Janine Austin Clayton, M.D., NIH associate director for women's health research, said in the announcement.

Kimberly Skelding, M.D., (pictured) an interventional cardiologist at Geisinger Health System based in Danville, Pennsylvania, does considerable research related to women's health issues. Skelding hopes to combine education, research and service to meet the need she hears about from patients and to address the area population's service needs, she said in an exclusive interview with FierceHealthcare.

Skelding worked with the Society for Cardiovascular Angiography and Interventions to investigate how medical researchers can include more minorities in general in studies. She also worked with the Agency for Healthcare Research and Quality, as well as the Federal Drug Administration and other organizations to gather data regarding the gaps in medical professionals' knowledge base when it comes to how different sexes react to treatments.  

She sits on a committee that focuses on increasing the amount of data on women in cardiovascular disease research in stent trials and pull the data to identify areas that need improvement. Initially women, were excluded from clinical trials. Although women are now included in more contemporary trials, there aren't enough of them enrolled to find definitive data to see how the trials affect women's health, Skelding said. "There's a potential to find out that maybe certain devices or drugs that have an increase efficacy in women or on the flip side that they could be more damaging to women," she told FierceHealthcare.

As a result, she said, researchers could miss data that is helpful or harmful when it comes to women's health. There are specific disparities in intervention trials, but  doctors and hospitals can take a stand against inequity in healthcare.

First, physicians and healthcare organizations must recognize and acknowledge there are biological differences between the sexes, and men and women can react differently to the same treatment based on the physiological differences, Skelding said. Hospitals must establish a tangible and measurable action plan to increase the enrollment for women in clinical trials, and increase the number of trials that answer questions about the differences in women and how they respond to treatment.

Once research happens, hospitals and physicians must hardline the new data into the curricula of how they deal with and treat women, especially when it comes to cardio vascular health problems. Finally, doctors and hospitals must encourage women to advocate for themselves when they seek treatment, ask questions and be open to participating in clinical trials, she said.

At Geisinger, Skelding takes a blanket approach and encourages all patients to give consent for clinical trials, which immediately allows women at least the opportunity to participate. "Women tend to participate more frequently when there's a woman principle investigator," she added.

Skelding and her team at Geisinger also provide education for nurses and ancillary staff, and ask speakers to make note of cases when there is not sex-specific data to share. Finally, Geisinger expands education formally into the educational criteria. Skelding hopes to embed that into the medical education process in medical schools as well.

"Both healthcare providers and lay people are uncertain that there is a sex difference in their medical treatment, but the science tells us a different story," Skelding said. "... we know there is a huge difference in how women and men have heart disease, have heart attacks and respond to treatment." 

A Healthgrades report from earlier this year found hospital administrators that want to strengthen their organizations' relationships with female patients should emphasize care quality and outcomes, which women tend to prioritize over cost, FierceHealthcare previously reported. Care quality and outcomes are major factors in women's long-term relationships with hospitals and providers, and hospitals should emphasize those aspects when communicating with and educating female patients.

To learn more:
- read the NIH announcement