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

Abstract

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.