Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction

S. R. Majumdar, Thomas Inui, J. H. Gurwitz, M. W. Gillman, T. J. McLaughlin, S. B. Soumerai

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

OBJECTIVE: Recent reports have linked calcium channel blockers (CCBs) with an 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 cardiologist attendings. 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, β-blockers, thrombolytic therapy) and ineffective AMI treatments lidoeaine). SETTING: Thirty-seven community-based hospitals in Minnesota. PATIENTS: Population-based sample of 5,347 patients admitted with AMI. MEASUREMENTS: The primary outcome was prescription of a CCB at the time of discharge 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 less likely to use aspirin (37% vs 68%; adjusted odds ratio [OR], 0.58; 95% confidence interval [95% CI], 0.42 to 0.80) and thrombolyties (29% vs 64%; adjusted OR, 0.18; 95% CI, 0.13 to 0.25), but not β-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 not modified by, the involvement of a cardiologist. CONCLUSIONS: Compared with cardiologists, generalist physicians were less likely to adopt some effective AMI therapies, particularly those associated with risk such as thrombolytie 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.

Original languageEnglish (US)
Pages (from-to)351-359
Number of pages9
JournalJournal of General Internal Medicine
Volume16
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Calcium Channel Blockers
Myocardial Infarction
Physicians
Odds Ratio
Confidence Intervals
Therapeutics
Aspirin
Hospitalization
Pharmacopoeias
Thrombolytic Therapy
Community Hospital
Prescriptions
Cardiologists
Referral and Consultation

Keywords

  • Acute myocardial infarction
  • Adoption
  • Calcium channel blockers
  • Drug utilization
  • Physician specialty
  • Prescribing
  • Relinquishment

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction. / Majumdar, S. R.; Inui, Thomas; Gurwitz, J. H.; Gillman, M. W.; McLaughlin, T. J.; Soumerai, S. B.

In: Journal of General Internal Medicine, Vol. 16, No. 6, 2001, p. 351-359.

Research output: Contribution to journalArticle

Majumdar, S. R. ; Inui, Thomas ; Gurwitz, J. H. ; Gillman, M. W. ; McLaughlin, T. J. ; Soumerai, S. B. / Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction. In: Journal of General Internal Medicine. 2001 ; Vol. 16, No. 6. pp. 351-359.
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AU - Majumdar, S. R.

AU - Inui, Thomas

AU - Gurwitz, J. H.

AU - Gillman, M. W.

AU - McLaughlin, T. J.

AU - Soumerai, S. B.

PY - 2001

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N2 - OBJECTIVE: Recent reports have linked calcium channel blockers (CCBs) with an 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 cardiologist attendings. 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, β-blockers, thrombolytic therapy) and ineffective AMI treatments lidoeaine). SETTING: Thirty-seven community-based hospitals in Minnesota. PATIENTS: Population-based sample of 5,347 patients admitted with AMI. MEASUREMENTS: The primary outcome was prescription of a CCB at the time of discharge 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 less likely to use aspirin (37% vs 68%; adjusted odds ratio [OR], 0.58; 95% confidence interval [95% CI], 0.42 to 0.80) and thrombolyties (29% vs 64%; adjusted OR, 0.18; 95% CI, 0.13 to 0.25), but not β-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 not modified by, the involvement of a cardiologist. CONCLUSIONS: Compared with cardiologists, generalist physicians were less likely to adopt some effective AMI therapies, particularly those associated with risk such as thrombolytie 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.

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KW - Acute myocardial infarction

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KW - Calcium channel blockers

KW - Drug utilization

KW - Physician specialty

KW - Prescribing

KW - Relinquishment

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