Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults
Abstract Background Although lipid-lowering drugs are not recommended for primary prevention in patients 75+, prevalence of use is high and there is unexplained variation in prescribing between physicians. The objective of this study was to determine if physician communication ability and clinical c...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04429-5 |
| _version_ | 1797451544621219840 |
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| author | Robyn Tamblyn Teresa Moraga Nadyne Girard Fiona K. I. Chan Bettina Habib John Boulet |
| author_facet | Robyn Tamblyn Teresa Moraga Nadyne Girard Fiona K. I. Chan Bettina Habib John Boulet |
| author_sort | Robyn Tamblyn |
| collection | DOAJ |
| description | Abstract Background Although lipid-lowering drugs are not recommended for primary prevention in patients 75+, prevalence of use is high and there is unexplained variation in prescribing between physicians. The objective of this study was to determine if physician communication ability and clinical competence are associated with prescribing lipid-lowering drugs for primary and secondary prevention. Methods We used a cohort of 4,501 international medical graduates, 161,214 U.S. Medicare patients with hyperlipidemia (primary prevention) and 49,780 patients with a history of cardiovascular disease (secondary prevention) not treated with lipid-lowering therapy who were seen by study physicians in ambulatory care. Clinical competence and communication ability were measured by the ECFMG clinical assessment examination. Physician citizenship, age, gender, specialty and patient characteristics were also measured. The outcome was an incident prescription of lipid-lowering drug, evaluated using multivariable GEE logistic regression models for primary and secondary prevention for patients 75+ and 65-74. Results Patients 75+ were less likely than those 65-74 to receive lipid-lowering drugs for primary (OR 0.62, 95% CI 0.59-0.66) and secondary (OR 0.70, 95% CI 0.63-0.78) prevention. For every 20% increase in clinical competence score, the odds of prescribing therapy for primary prevention to patients 75+ increased by 24% (95% CI 1.02-1.5). Communication ability had the opposite effect, reducing the odds of prescribing for primary prevention by 11% per 20% score increase (95% CI 0.8-0.99) for both age groups. Physicians who were citizens of countries with higher proportions of Hispanic (South/Central America) or Asian (Asia/Oceania) people were more likely to prescribe treatment for primary prevention, and internal medicine specialists were more likely to treat for secondary prevention than primary care physicians. Conclusion Clinical competence, communication ability and physician citizenship are associated with lipid-lowering drug prescribing for primary prevention in patients aged 75+. |
| first_indexed | 2024-03-09T14:56:10Z |
| format | Article |
| id | doaj.art-6f20dc8917264a23a17c72927916531c |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-09T14:56:10Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-6f20dc8917264a23a17c72927916531c2023-11-26T14:10:28ZengBMCBMC Geriatrics1471-23182023-11-0123111010.1186/s12877-023-04429-5Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adultsRobyn Tamblyn0Teresa Moraga1Nadyne Girard2Fiona K. I. Chan3Bettina Habib4John Boulet5Department of Epidemiology, Biostatistics and Occupational Health, McGill UniversityClinical and Health Informatics Research Group, McGill UniversityClinical and Health Informatics Research Group, McGill UniversityDepartment of Epidemiology, Biostatistics and Occupational Health, McGill UniversityClinical and Health Informatics Research Group, McGill UniversityFoundation for Advancement of International Medical Education and Research (FAIMER)Abstract Background Although lipid-lowering drugs are not recommended for primary prevention in patients 75+, prevalence of use is high and there is unexplained variation in prescribing between physicians. The objective of this study was to determine if physician communication ability and clinical competence are associated with prescribing lipid-lowering drugs for primary and secondary prevention. Methods We used a cohort of 4,501 international medical graduates, 161,214 U.S. Medicare patients with hyperlipidemia (primary prevention) and 49,780 patients with a history of cardiovascular disease (secondary prevention) not treated with lipid-lowering therapy who were seen by study physicians in ambulatory care. Clinical competence and communication ability were measured by the ECFMG clinical assessment examination. Physician citizenship, age, gender, specialty and patient characteristics were also measured. The outcome was an incident prescription of lipid-lowering drug, evaluated using multivariable GEE logistic regression models for primary and secondary prevention for patients 75+ and 65-74. Results Patients 75+ were less likely than those 65-74 to receive lipid-lowering drugs for primary (OR 0.62, 95% CI 0.59-0.66) and secondary (OR 0.70, 95% CI 0.63-0.78) prevention. For every 20% increase in clinical competence score, the odds of prescribing therapy for primary prevention to patients 75+ increased by 24% (95% CI 1.02-1.5). Communication ability had the opposite effect, reducing the odds of prescribing for primary prevention by 11% per 20% score increase (95% CI 0.8-0.99) for both age groups. Physicians who were citizens of countries with higher proportions of Hispanic (South/Central America) or Asian (Asia/Oceania) people were more likely to prescribe treatment for primary prevention, and internal medicine specialists were more likely to treat for secondary prevention than primary care physicians. Conclusion Clinical competence, communication ability and physician citizenship are associated with lipid-lowering drug prescribing for primary prevention in patients aged 75+.https://doi.org/10.1186/s12877-023-04429-5Older adultsLipid-reducing drugsChoosing wisely |
| spellingShingle | Robyn Tamblyn Teresa Moraga Nadyne Girard Fiona K. I. Chan Bettina Habib John Boulet Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults BMC Geriatrics Older adults Lipid-reducing drugs Choosing wisely |
| title | Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults |
| title_full | Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults |
| title_fullStr | Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults |
| title_full_unstemmed | Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults |
| title_short | Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults |
| title_sort | clinical competence communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults |
| topic | Older adults Lipid-reducing drugs Choosing wisely |
| url | https://doi.org/10.1186/s12877-023-04429-5 |
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