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Titolo:
Influence of physician specialty on adoption and relinquishment of calciumchannel blockers and other treatments for myocardial infarction
Autore:
Majumdar, SR; Inul, TS; Gurwitz, JH; Gillman, MW; McLaughlin, TJ; Soumerai, SB;
Indirizzi:
Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, Boston, MA 02215 USA Harvard Univ Boston MA USA 02215 ory Care & Prevent, Boston, MA 02215 USA Harvard Pilgrim Hlth Care, Boston, MA 02215 USA Harvard Pilgrim Hlth CareBoston MA USA 02215 Care, Boston, MA 02215 USA Univ Alberta, Dept Med, Div Gen Internal Med, Edmonton, AB, Canada Univ Alberta Edmonton AB Canada v Gen Internal Med, Edmonton, AB, Canada Univ Massachusetts, Sch Med, Meyers Primary Care Inst, Worcester, MA USA Univ Massachusetts Worcester MA USA Primary Care Inst, Worcester, MA USA Fallon Healthcare Syst, Worcester, MA USA Fallon Healthcare Syst Worcester MA USA althcare Syst, Worcester, MA USA
Titolo Testata:
JOURNAL OF GENERAL INTERNAL MEDICINE
fascicolo: 6, volume: 16, anno: 2001,
pagine: 351 - 359
SICI:
0884-8734(200106)16:6<351:IOPSOA>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
GENERALIST PHYSICIANS; HELICOBACTER-PYLORI; UNITED-STATES; DRUG-THERAPY; CARE; MANAGEMENT; MORTALITY; OUTCOMES; DISEASE; CARDIOLOGISTS;
Keywords:
acute myocardial infarction; drug utilization; calcium channel blockers; physician specialty; prescribing; adoption; relinquishment;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
54
Recensione:
Indirizzi per estratti:
Indirizzo: Soumerai, SB Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, 126 Brookline Ave,Suite 200, Boston, MA 02215 USA Harvard Univ 126 Brookline Ave,Suite 200 Boston MA USA 02215
Citazione:
S.R. Majumdar et al., "Influence of physician specialty on adoption and relinquishment of calciumchannel blockers and other treatments for myocardial infarction", J GEN INT M, 16(6), 2001, pp. 351-359

Abstract

Objective: Recent reports have linked calcium channel blockers (CCBs) withan increased risk of acute myocardial infarction (AMI). We sought to determine to what extent physicians relinquished CCBs following these adverse reports and if there were differences in the use of CCBs and other AMI therapies across 3 levels of specialist involvement: generalist attendings, collaborative care (generalist with cardiologist consultation), and cardiologistattendings. Design: We measured use of CCBs during hospitalization for AMI before (1992-1993) and after (1995-1996) the adverse CCB reports, controlling for hospital-, physician-, and patient-level variables. We also examined use of effective medications (aspirin, beta -blockers, thrombolytic therapy) and ineffective AIM treatments (lidocaine). Setting: Thirty-seven community-based hospitals in Minnesota. Patients: Population-based sample of 5,347 patients admitted with AIM. Measurements: The primary outcome was prescription of a CCB at the time ofdischarge from hospital. Secondary outcomes included use of other effective and ineffective AMI therapies during hospitalization and at discharge. Main Results: Compared with cardiologists, generalist attendings were lesslikely to use aspirin (37% vs 68%; adjusted odds ratio [OR], 0.58; 95% confidence interval [95% CI], 0.42 to 0.80) and thrombolytics (29% vs 64%; adjusted OR, 0.18: 95% CI, 0.13 to 0.25), but not beta -blockers (20% vs 46%; adjusted OR, 0.93; 95% CI, 0.66 to 1.31). From 1992-1993 to 1995-1996, the use of CCBs in patients with AMI decreased from 24% to 10%, the net result of physicians starting CCBs less often and discontinuing them more often. In multivariate models, the odds of CCB relinquishment after the adverse reports (adjusted OR, 0.33; 95% CI, 0.27 to 0.39) were independent of, and notmodified-by, the involvement of a cardiologist. Conclusions: Compared with cardiologists, generalist physicians were less likely to adopt some effective AMI therapies, particularly those associatedwith risk such as thrombolytic therapy. However, generalists were as likely as cardiologists to relinquish CCBs after the adverse reports. This pattern of practice may be the generalist physicians' response to an expanding, but increasingly risky and uncertain, pharmacopoeia.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/05/20 alle ore 04:45:26