Effect of Attending Practice Style on Generic Medication Prescribing by Residents in the Clinic Setting: An Observational Study
Effect of Attending Practice Style on Generic Medication Prescribing by Residents in the Clinic Setting: An Observational Study
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DOI：
10.1007/s11606-015-3323-5
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发表时间：
2015-09-01
影响因子：
5.7
通讯作者：
Epstein, Andrew J.
中科院分区：
文献类型：
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作者：
Ryskina, Kira L.;Dine, C. Jessica;Epstein, Andrew J.
尽管研究生医学培训越来越重视成本意识，但很少有经验证据表明主治医师监督对住院医师实践的作用。为了研究主治医师的处方实践是否影响住院医师在门诊环境中开具品牌他汀类药物的处方。使用 2007 年 7 月至 2011 年 11 月的电子病历数据，对两个内科住院医师项目的住院医师的他汀类药物处方进行了回顾性研究。我们估计了多变量分层逻辑回归模型评估上一季度主治医师开出品牌处方药的比例对住院医师开出品牌他汀类药物的可能性的独立影响。样本包括 342 名住院医师和 58 名主治医师，共 10,151 份初始他汀类药物处方，其中 3,942 份由住院医师开具。大约四分之一的患者服用了品牌他汀类药物。在调整患者、医生和实践层面的因素后，主治医生在就诊前一个季度的品牌处方率与研究生 (PGY)-1 住院医师开出品牌他汀类药物的处方呈正相关，但与 PGY-2 或 PGY-3 住院医师无关。对于 PGY-1 住院医师，上一季度服用品牌他汀类药物的主治医师监督下的住院医师开出品牌他汀类药物的调整概率为 22.6%（95% CI 17.3-28.0%，p < 0.001）到 41.6%（95% CI 24.6-58.5%，p < 0.001）。 0.001) 对于在上一季度至少开出 80% 品牌他汀类药物的主治医生监督的居民。较高的 PGY 水平与品牌处方相关（PGY-2 的 aOR 2.07，95 % CI 1.28-3.35，p = 0.003；PGY-3 的 aOR 2.15，95 % CI 1.31-3.55，p = 0.003，与 PGY-1 相比）。品牌药物可能对 PGY-1 居民的品牌药物处方有显着影响，但对老年居民的处方没有影响。
Despite increased emphasis on cost-consciousness in graduate medical training, there is little empirical evidence of the role of attending physician supervision on resident practice in this area.To study whether the prescribing practices of attendings influence residents' prescribing of brand-name statin medications in the ambulatory clinic setting.A retrospective study of statin prescriptions by residents at two internal medicine residency programs, using electronic medical record data from July 2007 through November 2011.We estimated multivariable hierarchical logistic regression models to assess the independent effect of the supervising attending's rate of brand-name prescribing in the preceding quarter on the likelihood of a resident prescribing a brand-name statin.The sample included 342 residents and 58 attendings, accounting for 10,151 initial statin prescriptions, including 3,942 by residents. Brand-name statins were prescribed in about one-fourth of encounters. After adjusting for patient-, physician-, and practice-level factors, the supervising attendings' brand-name prescribing rate in the quarter preceding the encounter was positively associated with a postgraduate year (PGY)-1 resident's prescribing a brand-name statin, but not for PGY-2 or PGY-3 residents. For PGY-1 residents, the adjusted probability of a resident prescribing a brand-name statin ranged from 22.6 % (95 % CI 17.3-28.0 %, p < 0.001) for residents supervised by an attending who prescribed < 20 % brand-name statins in the previous quarter to 41.6 % (95 % CI 24.6-58.5 %, p < 0.001) for residents supervised by an attending who prescribed at least 80 % brand-name statins in the previous quarter. A higher PGY level was associated with brand-name prescribing (aOR 2.07, 95 % CI 1.28-3.35, p = 0.003 for PGY-2; aOR 2.15, 95 % CI 1.31-3.55, p = 0.003 for PGY-3, vs. PGY-1).Supervising attendings' prescribing of brand-name medications may have a significant influence on PGY-1 residents' prescribing of brand-name medications, but not on prescribing by more senior residents.