The Effect of Physicians' Training on Prescribing β-Blockers for Secondary Prevention of Myocardial Infarction in the Elderly

• Published in: Annals of epidemiology 2002-02, Vol.12 (2), p.86-89
• Main Authors: Levy, Adrian R, Tamblyn, Robyn M, Mcleod, Peter J, Fitchett, David, Abrahamowicz, Michal
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Aged; Canada; Cohort Studies; Female; Humans; Male; Myocardial Infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - prevention & control; Odds Ratio; Physician Behavior; Practice Patterns, Physicians' - statistics & numerical data; Prescribing; Retrospective Studies; Secondary Prevention; Sex Factors; β-Blockers
• ISSN: 1047-2797; 1873-2585
• DOI: 10.1016/S1047-2797(01)00251-4

PURPOSE: The objective was to determine whether the year and medical school of graduation, the medical specialty and the sex of the treating physician was associated with prescribing β-blockers after hospital discharge among survivors of myocardial infarction (MI), after adjusting for patient characteristics. METHODS: We carried out a dynamic retrospective cohort study using data from a longitudinal database that contained information on Quebec residents over the age of 65 years sent home from hospital after MI between 1990 and 1993. The outcome was a β-blocker being dispensed after hospital discharge. Logistic regression was used to estimate the association between training characteristics and β-blocker dispensation and clustering of patients within physicians was accounted for using Generalized Estimating Equations. RESULTS: The cohort consisted of 14,334 MI survivors who were treated by 3209 physicians, yielding a mean of about 4.5 patients per physician [standard deviation (SD) = 8.2]. β-blockers were prescribed to approximately one-third of subjects. After adjusting for patients' demographic characteristics, comorbid medical conditions, and markers of MI severity, physicians who were more likely to prescribe a β-blocker included cardiologists and the most recent graduates (graduating after 1989). Systematic differences were also observed between graduates of different medical schools. CONCLUSIONS: After adjusting for differences between patients', the sex of the physician was largely unrelated to prescribing β-blockers for secondary prevention of MI. However, prescribing differed by training characteristics such as medical specialty and year and medical school of graduation.