Beers M H, Fingold S F, Ouslander J G, Reuben D B, Morgenstern H, Beck J C
Merck & Co, Inc. Merck Research Labs, West Point, PA 19486-0004.
J Am Geriatr Soc. 1993 Aug;41(8):802-7. doi: 10.1111/j.1532-5415.1993.tb06173.x.
To describe the professional characteristics of doctors practicing in nursing homes and to determine whether those characteristics correlate with quality of prescribing.
A prospective, cohort study.
306 physicians practicing in 12 nursing homes in greater Los Angeles.
We surveyed doctors about their age, sex, education, credentials, and NH practice. We also determined medication orders for a 1-month period and evaluated them using explicit criteria for appropriateness developed by an expert panel.
We obtained data from 72% of MDs. Respondents had a mean age of 53 years (29-78) and were 94% male. Fifty-seven percent trained in internal medicine, 20% graduated outside the US or Canada, 67% were board certified in their declared specialty, and 5% had a certificate of added qualification in geriatrics (CAQ). Sixteen percent spent > 10% of their professional time in NHs, and 46% had NH practices that were > 20% Medicaid; most did not consult psychiatrists when prescribing psychoactive drugs. Forty percent of residents had at least one inappropriate prescription. The characteristics of doctors associated with the best prescribing quartile were female sex, CAQ, no board certification, and frequent consultation with psychiatrists. The characteristics of doctors in the most inappropriate quartile were older age, graduation from medical school before 1965, graduation from US medical school, small NH practice, and infrequent consultation with psychiatrists.
Although the quality of prescribing in nursing homes is related to some physician characteristics, the relationships are not those most commonly stated.
描述在疗养院执业医生的专业特征，并确定这些特征是否与处方质量相关。
一项前瞻性队列研究。
在大洛杉矶地区12家疗养院执业的306名医生。
我们调查了医生的年龄、性别、教育程度、资质以及在疗养院的执业情况。我们还确定了1个月期间的用药医嘱，并使用专家小组制定的明确适当性标准对其进行评估。
我们从72%的医生处获得了数据。受访者的平均年龄为53岁（29 - 78岁），男性占94%。57%接受过内科培训，20%在美国或加拿大以外地区毕业，67%在其宣称的专业领域获得了委员会认证，5%拥有老年医学附加资格证书（CAQ）。16%的医生将其专业时间的10%以上用于疗养院工作，46%的医生在疗养院的业务中有20%以上是为医疗补助计划患者服务；大多数医生在开具精神活性药物时不咨询精神科医生。40%的居民至少有一张不适当的处方。与最佳处方四分位数相关的医生特征为女性、拥有CAQ、无委员会认证以及经常咨询精神科医生。在最不适当四分位数中的医生特征为年龄较大、1965年以前毕业于医学院、毕业于美国医学院、疗养院业务规模小以及很少咨询精神科医生。
虽然疗养院的处方质量与一些医生特征有关，但这些关系并非最常提及的那些。
