Home About us Contact
|
Home About us Contact | ||
|
|
||
Physician Characteristics (physician + characteristic)
Selected AbstractsPhysician characteristics associated with prescription of inappropriate medications using Beers criteriaGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2007Hirohisa Imai Background: The prescription of potentially inappropriate medications (PIM) for elderly patients represents a major problem. In the published work, various practice characteristics associated with physicians prescribing habits have been reported. However, existing data has shed little light on the characteristics of physicians who tend to prescribe PIM. We examined whether personal, professional or practice characteristics differ between physicians who prescribe PIM and those who do not. Methods: The subjects comprised primary care and general practice physicians. Physicians were identified from the pharmacy database of a managed care organization as having prescribed medications for Medicare patients over 65 years enrolled in a managed care plan. We adopted Beers criteria to describe the prevalence of PIM use. The physicians were divided into three groups according to number of PIM prescribed. To examine the extent of associations between all the physician-related characteristics studied, polychotomous logistic regression was conducted. Results: Physicians who prescribed one to five PIMs were 0.63 (95% confidence interval [CI], 0.41,0.98) times more likely to have publications than physicians who prescribed no PIM. Physicians who prescribed more than six PIM were 3.18 (95% CI, 2.05,4.95) times more likely to be certified by an internal medicine board, 0.48 (95% CI, 0.30,0.78) times more likely to have publications, and 1.84 (95% CI, 1.01,3.35) times more likely to be in solo practice than physicians who prescribed no PIM. Conclusion: In this study, we found three predictors of PIM prescribing incidence. Since the current study could only describe associations and not causality, further research is necessary. [source] Relationship Between Patient Age and Duration of Physician Visit in Ambulatory Setting: Does One Size Fit All?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Agnes Lo BSP, PharmD Objectives: To determine whether patient age, the presence of comorbid illness, and the number of prescribed medications influence the duration of a physician visit in an ambulatory care setting. Design: A cross-sectional study of ambulatory care visits made by adults aged 45 and older to primary care physicians. Setting: A probability sample of outpatient follow-up visits in the United States using the National Ambulatory Medical Care Survey (NAMCS) 2002 database. Participants: Of 28,738 physician visits in the 2002 NAMCS data set, there were 3,819 visits by adults aged 45 and older included in this study for analysis. Measurements: The primary endpoint was the time that a physician spent with a patient at each visit. Covariates included for analyses were patient characteristics, physician characteristics, visit characteristics, and source of payment. Visit characteristics, including the number of diagnoses and the number of prescribed medications, the major diagnoses, and the therapeutic class of prescribed medications, were compared for different age groups (45,64, 65,74, and ,75) to determine the complexity of the patient's medical conditions. Endpoint estimates were computed by age group and were also estimated based on study covariates using univariate and multivariate linear regression. Results: The mean time±standard deviation spent with a physician was 17.9±8.5 minutes. There were no differences in the duration of visits between the age groups before or after adjustment for patient covariates. Patients aged 75 and older had more comorbid illness and were prescribed more medications than patients aged 45 to 64 and 65 to 74 (P<.001). Patients aged 75 and older were also prescribed more medications that require specific monitoring and counseling (warfarin, digoxin, angiotensin-converting enzyme inhibitors, diuretics, and levothyroxine) than were patients in other age groups (P<.001). Hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, cerebrovascular disease, and transient ischemic attack were more common in patients aged 75 and older than in other age groups (P<.001). Despite these differences, there were no differences in unadjusted or adjusted duration of physician visit between the age groups. Conclusion: Although patients aged 75 and older had more medical conditions and were at higher risk for drug-related problems than younger patients, the duration of physician visits was similar across the age groups. These findings suggest that elderly patients may require a multidisciplinary approach to optimize patient care in the ambulatory setting. [source] Patient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Jagdish S. Nachnani MD Abstract BACKGROUND: The use of acid suppressive therapy (AST) in prevention of stress ulcers has been well defined in critical care patients, though its use has become increasingly common in general medicine patients, with little to no supportive evidence. None of the previous studies has examined the patient and physician characteristics of inappropriate AST initiation and use in hospitalized patients. The aim of our study was to identify: (1) the appropriateness of AST in hospitalized patients and the cost associated with inappropriate use; and (2) patient and physician characteristics predicting inappropriate initiation and use of AST. METHODS: All discharges over a period of 8 consecutive days were selected. RESULTS: There were 207 patients discharged over a period of 8 days. AST was inappropriately initiated in 92 of 133 (69.2%) patients included in our study. On univariate analysis, higher hemoglobin value, postgraduate year 1 (PGY-1) residents, physicians with an MD degree, international medical graduates (IMGs), and internal medicine physicians were more likely to prescribe AST inappropriately. On multivariate analysis, a higher hemoglobin value, PGY-1 residents, and MD physicians were factors associated with inappropriate AST use. The total direct patient cost for this inappropriate use was $8026, with an estimated annual cost of approximately $366,000. CONCLUSIONS: AST was inappropriately initiated in 69.2% of patients with increased direct costs of $8026. Residents in their first year of training as well physicians with a MD degree are more likely to initiate AST inappropriately. Curtailing the inappropriate use of AST therapy may reduce overall costs for the patient and institution. Journal of Hospital Medicine 2009;4:E10,E14. © 2009 Society of Hospital Medicine. [source] Risk factors for suicide following hospital discharge among cancer patientsPSYCHO-ONCOLOGY, Issue 10 2009Herng-Ching Lin Abstract Objectives: This study aims to examine risk factors associated with 3-month post-discharge suicide among cancer patients using Taiwan's nationwide, population-based datasets. Methods: The study cohort comprised all cancer patients discharged from hospitals from 2002 to 2004, inclusive, who committed suicide within 90 days of discharge (n=311). The control group consisted of 1555 cancer patients who did not commit suicide within 90 days of discharge. The dependent variable was whether or not a patient committed suicide within 90 days of discharge, while the independent variables included patient, hospital and physician characteristics at index hospitalization. Cox proportional hazard regression was carried out to compute the 90-day survival rate, adjusting for possible confounding factors. Results: The mean interval from discharge to suicide was 39.7 days (±95.2) and almost half (46.3%) of the 3-month post-discharge suicides occurred within 14 days after discharge. The adjusted hazard of committing suicide for patients who were not hospitalized in the preceding year was 1.68 (p=0.009), 1.61 (p=0.033), and 2.51 (p<0.001) times greater, respectively, than patients who were hospitalized once, twice and more than twice within the year before index hospitalization. The hazard of committing suicide among patients who were unemployed was 1.71 (p<0.001) times that of their employed counterparts. Conclusions: We conclude that, while our study was limited to suicides among cancer patients within 90 days of discharge, around 60% of deaths occurred within the first month after discharge. The relevant risk factors include the number of hospitalizations within 1 year and employment status. Copyright © 2009 John Wiley & Sons, Ltd. [source] Rural,Urban Differences in Primary Care Physicians' Practice Patterns, Characteristics, and IncomesTHE JOURNAL OF RURAL HEALTH, Issue 2 2008William B. Weeks MD ABSTRACT:,Context:Low salaries and difficult work conditions are perceived as a major barrier to the recruitment of primary care physicians to rural settings. Purpose: To examine rural,urban differences in physician work effort, physician characteristics, and practice characteristics, and to determine whether, after adjusting for any observed differences, rural primary care physicians' incomes were lower than those of urban primary care physicians. Methods: Using survey data from actively practicing office-based general practitioners (1,157), family physicians (1,378), general internists (2,811), or pediatricians (1,752) who responded to the American Medical Association's annual survey of physicians between 1992 and 2002, we used linear regression modeling to determine the association between practicing in a rural (nonmetropolitan) or urban (standard metropolitan statistical area) setting and physicians' annual incomes after controlling for specialty, work effort, provider characteristics, and practice characteristics. Findings: Rural primary care physicians' unadjusted annual incomes were similar to their urban counterparts, but they tended to work longer hours, complete more patient visits, and have a much greater proportion of Medicaid patients. After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts (95% confidence intervals: ,$14,569, ,$4,602, P < .001). In particular, rural practicing general internists and pediatricians experienced lower incomes than did their urban counterparts. Conclusions: Addressing rural physicians' lower incomes, longer work hours, and greater dependence on Medicaid reimbursement may improve the ability to ensure that an adequate supply of primary care physicians practice in rural settings. [source] International Survey of Emergency Physicians' Awareness and Use of the Canadian Cervical-Spine Rule and the Canadian Computed Tomography Head RuleACADEMIC EMERGENCY MEDICINE, Issue 12 2008Debra Eagles MD Abstract Objectives:, The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use. Methods:, A self-administered e-mail and postal survey was sent to members of four national emergency physician (EP) associations using a modified Dillman technique. Results were analyzed using repeated-measures logistic regression models. Results:, The response rate was 54.8% (1,150/2,100). Reported awareness of the CCR ranged from 97% (Canada) to 65% (United States); for the CCHR it ranged from 86% (Canada) to 31% (United States). Reported use of the CCR ranged from 73% (Canada) to 30% (United States); for the CCHR, it was 57% (Canada) to 12% (United States). Predictors of awareness were country, type of rule, full-time employment, younger age, and teaching hospital (p < 0.05). Significant differences in use of the CCR by country were observed, but not for the CCHR. Teaching hospitals were more likely to use the CCR than nonteaching hospitals, but less likely to use the CCHR. Conclusions:, This large international study found notable differences among countries with regard to knowledge and use of the CCR and CCHR. Awareness and use of both rules were highest in Canada and lowest in the United States. While younger physicians, those employed full-time, and those working in teaching hospitals were more likely to be aware of a decision rule, age and employment status were not significant predictors of use. A better understanding of factors related to awareness and use of emergency medicine (EM) decision rules will enhance our understanding of knowledge translation and facilitate strategies to enhance dissemination and implementation of future rules. [source] Influence of private practice setting and physician characteristics on the use of breast cancer adjuvant chemotherapy for elderly women,,CANCER, Issue 17 2009Dawn L. Hershman MD Abstract BACKGROUND: Although >70% of younger women with nonmetastatic breast cancer (BC) received adjuvant chemotherapy, only approximately 15% to 20% of elderly women with BC received chemotherapy. The decision to treat may be associated with nonmedical factors, such as patient, physician, or practice characteristics. In the current study, the association between oncologist characteristics and the receipt of chemotherapy in elderly women with BC was evaluated. METHODS: Women aged >65 years who were diagnosed with American Joint Committee on Cancer stages I to III BC between 1991 and 2002 were identified in the Surveillance, Epidemiology, and End Results-Medicare database. The Physician Unique Identification Number was linked to the American Medical Association Masterfile to obtain information on oncologists. Investigated was the association between demographic, tumor, and oncologist-related factors and the receipt of chemotherapy, using Generalized Estimating Equations to control for clustering. Patients were defined as low risk (estrogen/progesterone receptor positive, stage I/II disease) and high risk (estrogen/progesterone receptor-negative, stage II/III disease). RESULTS: Of 42,544 women identified, 8714 (20%) were treated with adjuvant chemotherapy. In a hierarchical analysis, women who underwent chemotherapy were more likely be treated by oncologists primarily employed in a private practice (odds ratio [OR], 1.40; 95% confidence interval [95% CI], 1.23-1.59) and who graduated after 1975 (OR, 1.12; 95% CI, 1.01-1.26) and were less likely to have an oncologist trained in the United States (OR, 0.83; 95% CI, 0.74-0.93). The association between a private practice setting and the receipt of chemotherapy was found to be similar for patients at high risk (OR, 1.55) and low risk (OR, 1.35) for cancer recurrence. CONCLUSIONS: Elderly women with BC treated by oncologists who were employed in a private practice were more likely to receive chemotherapy. Efforts to determine whether these associations reflected experience, practice setting, insurance type, or other economic incentives are warranted. Cancer 2009. Published 2009 by the American Cancer Society. [source] Race, Segregation, and Physicians' Participation in MedicaidTHE MILBANK QUARTERLY, Issue 2 2006JESSICA GREENE Many studies have explored the extent to which physicians' characteristics and Medicaid program factors influence physicians' decisions to accept Medicaid patients. In this article, we turn to patient race/ethnicity and residential segregation as potential influences. Using the 2000/2001 Community Tracking Study and other sources we show that physicians are significantly less likely to participate in Medicaid in areas where the poor are nonwhite and in areas that are racially segregated. Surprisingly,and contrary to the prevailing Medicaid participation theory,we find no link between poverty segregation and Medicaid participation when controlling for these racial factors. Accordingly, this study contributes to an accumulating body of circumstantial evidence that patient race influences physicians' choices, which in turn may contribute to racial disparities in access to health care. [source] | ||||||||||