Do resident and staff physicians differ in the types and costs of antihypertensive drugs they select?

OBJECTIVE

To compare the types and costs of drugs prescribed by resident and staff physicians treating patients with uncomplicated essential hypertension.

DESIGN

Cross-sectional study, using a computer-based medical record database.

SETTING

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.

MEASUREMENTS AND MAIN RESULTS

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.

CONCLUSIONS

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.