Quality of cardiovascular disease preventive care and physician/practice characteristics.
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ABSTRACT: Background
Quality of cardiovascular disease (CVD) preventive care is suboptimal. Recent data correlated increasing years in practice for physicians with lower-quality health care.Objective
The purpose of this study was to assess physician awareness/adherence to national blood pressure, cholesterol, and CVD prevention guidelines for women according to physician/practice characteristics.Design
Standardized online survey and experimental case studies were administered to 500 randomly selected U.S. physicians. Multivariable regression models tested physician age, gender, specialty, and practice type as independent predictors of guideline awareness/adherence.Results
Compared with older physicians (50+ years), younger physicians (<50 years) reported a lower level of awareness of cholesterol guidelines (P=.04) and lower incorporation of women's guidelines (P=.02). Yet, older physicians were less likely to recommend weight management for high-risk cases (P=.03) and less confident in helping patients manage weight (P=.045) than younger physicians. Older physicians were also less likely to identify a low-density lipoprotein<100 mg/dL as optimal versus younger physicians (P=.01), as were solo versus nonsolo practitioners (P=.02). Solo practitioners were less aware of cholesterol guidelines (P=.04) and were more likely to prescribe aspirin for low-risk female patients than nonsolo practitioners (P<.01). Solo practitioners rated their clinical judgment as more effective than guidelines in improving patient health outcomes (P<.01) and more frequently rated the patient as the greatest barrier to CVD prevention versus nonsolo practitioners (P<.01).Conclusions
Though guideline awareness is high, efforts to promote their utilization are needed and may improve quality outcomes. Targeted education and support for CVD prevention may be helpful to older and solo physicians.
SUBMITTER: Christian AH
PROVIDER: S-EPMC1828095 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceBiosimilars, or highly similar versions of complex biologic drugs, have the potential to slow drug spending growth; however, biosimilar uptake in the United States has been slow. Little is known about barriers to biosimilar uptake following drug launch.ObjectiveTo examine the patient, physician, and practice characteristics associated with biosimilar use in the Medicare population.Design, setting, and participantsThis cross-sectional study used regression analysis to estimate the association between biosimilar use and various characteristics. Medicare fee-for-service beneficiaries who received a filgrastim product or an infliximab product between the launch of a class's first biosimilar (quarter 3 2015 for filgrastim-sndz and quarter 4 2016 for infliximab-dyyb) and December 2018. Data analysis was conducted from March to November 2020.ExposuresPatient demographic characteristics and product clinical indications; physician demographic characteristics, specialty, and volume of filgrastim or infliximab biologic administration; hospital size, ownership, 340B status, academic medical center status, and system affiliation; physician office size and multispecialty status.Main outcomes and measuresAdministration of a filgrastim or infliximab biosimilar.ResultsThe final filgrastim sample included 25 870 patients (11 857 [45.8%] men; 14 224 [55.0%] aged 65-74 years; 22 617 [87.4%] White individuals) who had 259 178 administrations (79 017 [30.5%] biosimilar administrations), and the final infliximab sample included 14 786 patients (4765 [32.2%] men; 8773 [59.3%] aged 65-74 years; 13 467 [91.1%] White individuals) who had 174 973 administrations (9012 [5.2%] biosimilar administrations). In adjusted analyses, no patient demographic characteristics and 2 of 9 clinical indications (22.2%) were associated with biosimilar use (filgrastim, neutropenia: adjusted difference, -2.0 [95% CI, -3.9 to -0.2] percentage points; P = .03; infliximab, Crohn disease: adjusted difference, -1.8 [95% CI, -2.9 to -0.8] percentage points; P = .001). Several physician characteristics were associated with biosimilar administrations, including high filgrastim or infliximab prescribing volume (high vs low volume, filgrastim: adjusted difference, 3.6 [95% CI, 1.5 to 5.8] percentage points; P = .001; infliximab: adjusted difference, 1.2 [95% CI, 0.3 to 2.2] percentage points; P = .007) and specialty (eg, hematologist-oncologists vs primary care, filgrastim: adjusted difference, -3.0 [95% CI, -5.4 to -0.5] percentage points; P = .02). Numerous practice characteristics were associated with biosimilar use, including practice setting (outpatient hospital department vs office practice, filgrastim: adjusted difference, -16.1 [95% CI, -18.1 to -14.1] percentage points; P < .001; infliximab: adjusted difference, 3.0 [95% CI, 2.2 to 3.7] percentage points; P < .001) and hospital outpatient department ownership status (for-profit vs not-for-profit, filgrastim: adjusted difference, -17.4 [95% CI, -21.6 to -13.3] percentage points; P < .001; infliximab: adjusted difference, 10.8 [95% CI, 6.7 to 14.9] percentage points; P < .001).Conclusions and relevanceIn this study, practice setting and hospital ownership status had the largest associations with biosimilar usage, suggesting practices play a role in steering physicians toward certain medications. However, the types of practices with high biosimilar use differed by drug class. Further research is needed to understand the reasons for these differences across drug classes.
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