From the Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, Auburn, Alabama.
Department of Pharmacy Practice, Auburn University, Harrison School of Pharmacy, Auburn, Alabama.
J Patient Saf. 2022 Mar 1;18(2):e424-e430. doi: 10.1097/PTS.0000000000000838.
Coordination of medication prescribing is important in the care of patients with multiple chronic conditions (MCC) given the involvement of multiple providers and multiple medications used to manage MCC. The objective of this study was to identify physician and practice factors associated with physicians' coordination of prescribing for complex patients with MCC.
Our cross-sectional study used a 33-item anonymous, online survey to assess physicians' coordination practices while prescribing for patients with MCC. We sampled primary care physicians (PCPs), psychiatrists, and oncologists across the United States. Coordination of medication prescribing was measured on a 7-point Likert-type scale. χ2, Fisher exact test, and binomial logistic regression, adjusted for factors and covariates, were used to determine differences in coordination of prescribing. Average marginal effects were calculated for factors.
A total of 50 PCPs, 50 psychiatrists, and 50 oncologists participated. Most psychiatrists (56%) and oncologists (52%) reported frequently coordinating prescribing with other physicians, whereas less than half of the PCPs (42%) reported frequently coordinating prescribing. Female physicians were 25% points more likely to report coordinating prescribing than male physicians (P = 0.0186), and physicians not using electronic medical records were 30% points more likely to report coordinating prescribing than physicians using electronic medical records (P = 0.0230). Four additional factors were associated with lower likelihood of coordinating prescribing.
Physician and practice factors may influence differences in coordination of medication prescribing, despite physician specialty. These factors can provide a foundation for developing interventions to improve coordination of prescribing practices for MCC.
鉴于涉及多名提供者和多种药物用于治疗多种慢性疾病(MCC),因此,协调药物处方对于 MCC 患者的护理非常重要。本研究的目的是确定与复杂 MCC 患者的医生处方协调相关的医生和实践因素。
我们的横断面研究使用了 33 项匿名在线调查来评估医生在为 MCC 患者开处方时的协调实践。我们在美国各地抽取了初级保健医生(PCP)、精神科医生和肿瘤医生。药物处方的协调程度通过 7 点李克特量表进行测量。使用 χ2、Fisher 确切检验和二项逻辑回归,根据因素和协变量进行调整,以确定处方协调方面的差异。计算了因素的平均边际效应。
共有 50 名 PCP、50 名精神科医生和 50 名肿瘤科医生参与。大多数精神科医生(56%)和肿瘤科医生(52%)报告经常与其他医生协调处方,而不到一半的 PCP(42%)报告经常协调处方。女性医生报告协调处方的可能性比男性医生高 25%(P = 0.0186),不使用电子病历的医生比使用电子病历的医生更有可能报告协调处方,高出 30%(P = 0.0230)。还有四个其他因素与协调处方的可能性降低有关。
尽管医生的专业不同,但医生和实践因素可能会影响药物处方协调的差异。这些因素可以为改善 MCC 处方协调实践的干预措施提供基础。