Age, specialty, and practice setting predict gastroesophageal reflux disease prescribing behavior.
BACKGROUND
Gastroesophageal reflux disease (GERD) affects more than 40% of adults in the United States each month. Although the economic costs of treating this disorder are enormous, the attitudes and prescribing preferences of physicians who treat patients with GERD are not well known. This study was undertaken to determine physician prescribing practices in the treatment of GERD.


METHODS
A questionnaire was mailed to 687 randomly selected, practicing gastroenterologists, internists, and family physicians in the State of Maryland. Each questionnaire was identical and contained 7 questions designed to elicit demographic data (age, sex, degree, specialty, practice setting, years in practice, community served), and 16 questions related to the evaluation and treatment of GERD.


RESULTS
A total of 214 completed questionnaires were returned (31.1%), nearly equally distributed among the three different specialty groups. A total of 82% of the respondents were male; 60% of the respondents had practiced more than 15 years, and 6% had practiced 4 years or less. Older physicians prescribed proton pump inhibitors more often than younger physicians for mild or intermittent GERD symptoms. Physicians in an academic setting were more likely to use step-down therapy in patients with well-controlled GERD symptoms than were HMO-employed physicians. Family physicians requested a barium swallow in the evaluation of uncomplicated GERD more frequently than did gastroenterologists or internists. Gastroenterologists were more likely than family physicians and internists to recommend upper endoscopy for GERD patients with warning symptoms and for patients with long-standing reflux disease.


CONCLUSIONS
Age, specialty, number of years in practice, and practice setting significantly influence how physicians evaluate and treat patients with GERD. Educational efforts to improve the evaluation and treatment of patients with GERD may require different strategies for different types of healthcare providers.
Lacy
Brian E
BE
Marvin M. Schuster Center for Digestive and Motility Disorders, Johns Hopkins University School of Medicine, Baltimore, MD, USA. brian.lacy@hitchcock.org
Crowell
Michael D
MD
Riesett
Randal P
RP
Mitchell
Amy
A
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008396:Maryland; D008511:Medicine; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D054328:Proton Pump Inhibitors; D013038:Specialization; D011795:Surveys and Questionnaires; D014481:United States
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors