Kira L Ryskina1, C Jessica Dine, Esther J Kim, Tara F Bishop, Andrew J Epstein. 1. Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 13-30B4 13th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA, ryskina@mail.med.upenn.edu.
Abstract
BACKGROUND: 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. OBJECTIVE: To study whether the prescribing practices of attendings influence residents' prescribing of brand-name statin medications in the ambulatory clinic setting. DESIGN AND PARTICIPANTS: 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. MAIN MEASURES: 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. KEY RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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. OBJECTIVE: To study whether the prescribing practices of attendings influence residents' prescribing of brand-name statin medications in the ambulatory clinic setting. DESIGN AND PARTICIPANTS: 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. MAIN MEASURES: 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. KEY RESULTS: 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). CONCLUSIONS: 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.
Authors: Mitesh S Patel; Susan Day; Dylan S Small; John T Howell; Gillian L Lautenbach; Eliot H Nierman; Kevin G Volpp Journal: Ann Intern Med Date: 2014-11-18 Impact factor: 25.391
Authors: David A Davis; Paul E Mazmanian; Michael Fordis; R Van Harrison; Kevin E Thorpe; Laure Perrier Journal: JAMA Date: 2006-09-06 Impact factor: 56.272
Authors: Ateev Mehrotra; Rachel O Reid; John L Adams; Mark W Friedberg; Elizabeth A McGlynn; Peter S Hussey Journal: Health Aff (Millwood) Date: 2012-11 Impact factor: 6.301
Authors: Kira Ryskina; C Jessica Dine; Yevgeniy Gitelman; Damien Leri; Mitesh Patel; Gregory Kurtzman; Lisa Y Lin; Andrew J Epstein Journal: J Gen Intern Med Date: 2018-05-22 Impact factor: 5.128
Authors: Christopher Terndrup; Carl G Streed; Perry Tiberio; Marissa Black; John Davis; Ariella Apfel; Oni J Blackstock; E Jennifer Edelman; Gail Berkenblit Journal: J Gen Intern Med Date: 2019-07 Impact factor: 5.128
Authors: Jennifer N Howard; Ilene Harris; Gavriella Frank; Zippora Kiptanui; Jingjing Qian; Richard Hansen Journal: Res Social Adm Pharm Date: 2017-08-04
Authors: Timothy S Anderson; Wei-Hsuan Lo-Ciganic; Walid F Gellad; Rouxin Zhang; Haiden A Huskamp; Niteesh K Choudhry; Chung-Chou H Chang; Seth Richards-Shubik; Hasan Guclu; Bobby Jones; Julie M Donohue Journal: Healthc (Amst) Date: 2017-10-21
Authors: Kira L Ryskina; Cynthia D Smith; Vineet M Arora; Aimee K Zaas; Andrew J Halvorsen; Arlene Weissman; Sandhya Wahi-Gururaj Journal: Acad Med Date: 2018-10 Impact factor: 6.893
Authors: Jason M Moss; William E Bryan; Loren M Wilkerson; Heather A King; George L Jackson; Ryan K Owenby; Courtney H Van Houtven; Melissa B Stevens; James Powers; Camille P Vaughan; William W Hung; Ula Hwang; Alayne D Markland; Richard Sloane; William Knaack; Susan Nicole Hastings Journal: J Pharm Pract Date: 2017-12-25