title: Physician characteristics and the initiation of beta-adrenergic blocking agent therapy after acute myocardial infarction in a managed care population.
abstract: OBJECTIVE
  To determine the association between physician characteristics and the use of beta-adrenergic blocking agents after acute myocardial infarction in a national managed care organization.
  
  
  METHODS
  Retrospective administrative data analysis.
  
  
  METHODS
  The study cohort consisted of 473 physicians who prescribed the medications and 578 patients who (1) experienced an acute myocardial infarction between January 1, 1995, and December 31, 1996, with at least 1 cardiac medication claim within 7 days of hospital discharge; (2) were not previously taking beta-adrenergic blocking agents; and (3) had none of several defined contraindications to the medication. Using multivariate models, we assessed the relation between physician characteristics and initiation of beta-adrenergic blocking agent therapy, controlling for patient characteristics and cardiac treatments.
  
  
  RESULTS
  Sixty-two percent of patients filled a prescription for beta-adrenergic blocking agents within 7 days of hospital discharge. Physician characteristics, including specialty and region of hospitalization, were independently associated with the use beta-adrenergic blocking agents. Family practice physicians and other noninternists were much less likely than cardiologists to prescribe beta-adrenergic blocking agents. The other most important predictors of the use of beta-adrenergic blocking agents were region of hospitalization and patient age.
  
  
  CONCLUSIONS
  Physician characteristics are associated with the use of beta-adrenergic blocking agents. Although there are opportunities to improve practice for all physicians, family practice physicians and noninternists have the most opportunity to improve.
authors.affiliation: USQA Center for Health Care Research, 2850 Paces Ferry Road, Suite 330, Atlanta, GA 30339, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Fehrenbach
authors.forename: D S
authors.initials: DS
authors.lastname: Budnitz
authors.forename: J A
authors.initials: JA
authors.lastname: Gazmararian
authors.forename: H M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008511:Medicine / Q000592:standards; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013038:Specialization; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists