The effect of physicians' training on prescribing beta-blockers for secondary prevention of myocardial infarction in the elderly.
OBJECTIVE
The objective was to determine whether the year and medical school of graduation, the medical specialty and the sex of the treating physician was associated with prescribing beta-blockers after hospital discharge among survivors of myocardial infarction (MI), after adjusting for patient characteristics.


METHODS
We carried out a dynamic retrospective cohort study using data from a longitudinal database that contained information on Quebec residents over the age of 65 years sent home from hospital after MI between 1990 and 1993. The outcome was a beta-blocker being dispensed after hospital discharge. Logistic regression was used to estimate the association between training characteristics and beta-blocker dispensation and clustering of patients within physicians was accounted for using Generalized Estimating Equations.


RESULTS
The cohort consisted of 14,334 MI survivors who were treated by 3209 physicians, yielding a mean of about 4.5 patients per physician [standard deviation (SD) = 8.2]. Beta-blockers were prescribed to approximately one-third of subjects. After adjusting for patients' demographic characteristics, comorbid medical conditions, and markers of MI severity, physicians who were more likely to prescribe a beta-blocker included cardiologists and the most recent graduates (graduating after 1989). Systematic differences were also observed between graduates of different medical schools.


CONCLUSIONS
After adjusting for differences between patients', the sex of the physician was largely unrelated to prescribing beta-blockers for secondary prevention of MI. However, prescribing differed by training characteristics such as medical specialty and year and medical school of graduation.
Levy
Adrian R
AR
Department of Health Care and Epidemiology, University of British Columbia and Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
Tamblyn
Robyn M
RM
Mcleod
Peter J
PJ
Fitchett
David
D
Abrahamowicz
Michal
M
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors
D000319:Adrenergic beta-Antagonists