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PLoS One. 2018 Oct 22;13(10):e0205524. doi: 10.1371/journal.pone.0205524. eCollection 2018.

Comparison of prescribing practices for older adults treated by female versus male physicians: A retrospective cohort study.

Author information

1
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
2
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
3
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
4
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
5
Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
6
Sinai Health System, Toronto, Ontario, Canada.
7
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
8
Institute for Clinical Evaluative Sciences, Kingston, Ontario, Canada.
9
Division of Geriatric Psychiatry, Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
10
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America.
11
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
12
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
13
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
14
Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.

Abstract

IMPORTANCE:

Subtle but important differences have been described in the way that male and female physicians care for their patients, with some evidence suggesting women are more likely to adhere to best practice recommendations.

OBJECTIVE:

To determine if male and female physicians differ in their prescribing practices as measured by the initiation of lower-than-recommended dose cholinesterase inhibitor (ChEI) drug therapy for dementia management.

DESIGN, SETTING, AND PARTICIPANTS:

All community-dwelling Ontario residents aged 66 years and older with dementia and newly dispensed an oral ChEI drug (donepezil, galantamine, or rivastigmine) between April 1, 2010 and June 30, 2016 were included.

MAIN OUTCOME AND MEASURES:

The association between physician sex and the initiation of a lower than recommended-dose ChEI was examined using generalized linear mixed regression models, adjusting for patient and physician characteristics. Data were stratified by specialty. Secondary analyses explored the association between physician sex and cardiac screening as well as shorter duration of the initial prescription.

RESULTS:

The analysis included 3,443 female and 5,811 male physicians and the majority (83%) were family physicians, Female physicians were more likely to initiate ChEI therapy at a lower-than-recommended dose (Adjusted odds ratio = 1.43,95% confidence interval = 1.17 to 1.74). Compared to their male counterparts, female physicians were also more likely to follow other conservative prescribing practices including cardiac screening (55.1% vs. 49.2%, P-value<0.001) around the time of ChEI initiation, and dispensing a shorter duration of initial prescription (41.8% vs 35.5% P-value<0.001).

CONCLUSIONS:

There is a statistically significant and important difference in ChEI prescribing patterns between female and male physicians, suggesting that female physicians may be more careful and conservative in their approaches. This will inform future research to determine if patients receiving lower-than-recommended initial doses also have better outcomes.

PMID:
30346974
PMCID:
PMC6197851
DOI:
10.1371/journal.pone.0205524
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

There is a data sharing agreement between the Institute for Clinical Evaluative Sciences (ICES) (a not for profit corporation) and the commercial company, IMS Brogan Inc., which governs a piece of the ICES data used to generate the project dataset. No employment relationship should be inferred in connection with this statement. No author on this work is employed by IMS Brogan. Dr. Gurwitz serves as a member of the UnitedHealthcare Pharmacy & Therapeutics Committee. Dr. Seitz involves in a clinical trial sponsored by Hoffman La Roche. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

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