Payne T H, Goodson J D, Morgan M M, Barnett G O
Department of Medicine, Massachusetts General Hospital, Boston.
J Gen Intern Med. 1991 Sep-Oct;6(5):439-44. doi: 10.1007/BF02598167.
To compare the types and costs of drugs prescribed by resident and staff physicians treating patients with uncomplicated essential hypertension.
Cross-sectional study, using a computer-based medical record database.
Primary care internal medicine clinic in a large teaching hospital.
PATIENTS/PARTICIPANTS: Hypertensive patients seen by ten postgraduate year-1 (PGY-1) and PGY-2 primary care internal medicine residents and four staff physicians practicing in the same clinic.
The types and costs of antihypertensive drugs prescribed for the patients treated by resident and staff physicians were compared. A larger proportion of patients of resident physicians than of staff physicians were treated with calcium channel blockers [19(15%) vs. 40(4%), p less than 0.001]; residents prescribed thiazide diuretics less frequently and beta-blockers more frequently than did staff physicians, although these differences were not significant. The estimated average wholesale price of antihypertensive drugs for patients cared for by residents was 35% higher than that for patients cared for by staff physicians ($0.73 vs. $0.54, p = 0.048). This difference was not fully explained by differences in practice composition.
Resident physicians in this study selected more expensive medications to treat hypertension than did their faculty preceptors, even when differences in practice composition were considered.
比较住院医师和主治医师为单纯性原发性高血压患者开具的药物类型及费用。
采用基于计算机的病历数据库进行横断面研究。
一家大型教学医院的初级保健内科诊所。
患者/参与者：由10名第一年（PGY - 1）和第二年（PGY - 2）初级保健内科住院医师以及在同一诊所执业的4名主治医师诊治的高血压患者。
比较住院医师和主治医师为患者开具的抗高血压药物的类型及费用。住院医师治疗的患者中，使用钙通道阻滞剂的比例高于主治医师[19例（15%）对40例（4%），p<0.001]；住院医师开具噻嗪类利尿剂的频率低于主治医师，开具β受体阻滞剂的频率高于主治医师，尽管这些差异不显著。住院医师诊治患者的抗高血压药物估计平均批发价高于主治医师诊治患者的平均批发价35%（0.73美元对0.54美元，p = 0.048）。实践构成的差异并不能完全解释这种差异。
在本研究中，即使考虑实践构成的差异，住院医师治疗高血压时选择的药物比带教教师选择的更昂贵。
