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Physicians-in-training likely to order brand-name statins when supervisors prefer them
Supervising physicians’ prescribing of brand-name statins appears to have a significant influence on first-year residents’ prescription habits, according to findings published in the Journal of General Internal Medicine.
The findings could have implications for training reforms to increase emphasis on cost-effectiveness, Kira L. Ryskina, MD, MS, told Cardiology Today.
“A report published by the Institute of Medicine in summer 2014 on financing of graduate medical education in the United States found that it is heavily subsidized by Medicare funding and recommended the funding be cut and reformed to incentivize more cost-effective care and other specific areas of need,” she said.
Cost-effectiveness an issue
Ryskina and colleagues examined statin prescriptions in that context because it had been identified as an area where cost-effectiveness could be improved as part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign.
In a retrospective study, Ryskina, a general internal medicine fellow at the Perelman School of Medicine at the University of Pennsylvania, and colleagues evaluated residents’ statin prescriptions at two internal medicine residency programs between July 2007 and November 2011.
The analysis included 342 residents and 58 attending physicians, with a total of 10,151 initial statin prescriptions (3,942 by residents).
Overall, brand-name statins were prescribed approximately 25% of the time, the researchers reported. After adjustment for patient-, physician- and practice-level factors, the rate at which supervising physician’s prescribed brand-name statins during the quarter preceding an encounter was positively associated with a first-year resident’s brand-name statin prescription rate, but not with that of second- or third-year residents, Ryskina and colleagues found.
Among first-year residents, those supervised by an attending physician who prescribed a brand-name statin less than 20% of the time during the previous quarter prescribed a brand-name statin 22.6% of the time (95% CI, 17.3-28; P < .001), but those who were supervised by an attending physician who prescribed a brand-name statin at least 80% of the time during the previous quarter prescribed a brand-name statin 41.6% of the time (95% CI, 24.6-58.5; P < .001), according to the researchers.
However, a higher post-graduate year level was associated with more frequent brand-name prescribing, they wrote. Compared with first-year residents, the adjusted OR for prescribing a brand-name statin was 2.07 (95% CI, 1.28-3.35) among second-year residents and 2.15 (95% CI, 1.31-3.55) among third-year residents.
Connection between mentors, trainees
The study “is early evidence that there is a connection between teaching/supervising physicians and what residents end up prescribing,” Ryskina told Cardiology Today. “The evidence is similar to other studies out there that looked at pharmaceutical profiling in medical schools and found that medical schools that had more pharmaceutical detailing had trainees who were prescribing those drugs. This is the first study of an example of cost-effective care, and hopefully this will support the work that organizations … are doing to support cost-effective care into graduate medical education as a way to improve cost-effective care overall. We can probably educate physicians more on these topics.”
One limitation is the difficulty of creating datasets combining multiple academic centers, “so it’s very challenging to tease out the practices of individual physicians vs. their supervising/attending physicians within each center,” she said. “We would like to collaborate with other institutions to put together a larger dataset and conduct more rigorous research.” – by Erik Swain
For more information:
Kira L. Ryskina, MD, MS, can be reached at Division of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 13-30B4 13th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; email: ryskina@mail.med.upenn.edu.
Disclosure: The researchers report no relevant financial disclosures.