(008) Association between physician characteristics and antiplatelet medication dispensed to community dwelling New Brunswick older adults following hospital discharge for myocardial infarction between 2009 and 2017
Background: Differences in medications dispensed after myocardial infarction (MI) based on the demographic characteristics of the treating physician have been documented
Objectives: The objective was to determine whether the medical specialty, the year and medical school of graduation, and the sex of the treating physician were associated with the likelihood a patient received an antiplatelet agent (P2Y12 inhibitor) after hospital discharge.
Methods: Administrative health databases were linked to conduct this retrospective cohort study. Subjects included community-dwelling individuals aged 66 years and older with publicly covered drug insurance who were discharged home from hospital after an MI between January 2009 and December 2017. The outcome was a dispensation of a P2Y12 inhibitor within 90 days of hospital discharge. Logistic regression was used to estimate the association between physician characteristics and P2Y12 dispensation after adjusting for patient demographic characteristics. The effect of “clustering” of subjects who were treated by the same physician was accounted for using generalized estimating equations.
Results: The study cohort consisted of 2674 MI subjects who were treated by 433 physicians, resulting in an average of 6.2 patients per physician (SD 17.6). In total, 70% of subjects received a P2Y12 inhibitor after hospital discharge. Subjects were almost three times more likely to receive a P2Y12 inhibitor if treated by a cardiologist [OR 2.7; 95% CI 2.0, 3.5] than if treated by a general practitioner. Subjects treated by a female physician were 30% less likely to receive a P2Y12 inhibitor [OR 0.7; 95% CI 0.5, 0.9] compared to those patients treated by a male physician. No systematic differences were observed between subjects treated by physicians based on location or year of medical school graduation.
Conclusions: These findings highlight practice variations in treating patients following MI in NB and can be used by policymakers to target interventions aimed at increasing guideline adherence.
