Comparison of prescribing practices for older adults treated by female versus male physicians: A retrospective cohort study

Abstract

ImportanceSubtle but important differences have been described in the way that male and female physicians care for their patients, with some evidence suggesting women are more likely to adhere to best practice recommendations.ObjectiveTo determine if male and female physicians differ in their prescribing practices as measured by the initiation of lower-than-recommended dose cholinesterase inhibitor (ChEI) drug therapy for dementia management.Design, setting, and participantsAll community-dwelling Ontario residents aged 66 years and older with dementia and newly dispensed an oral ChEI drug (donepezil, galantamine, or rivastigmine) between April 1, 2010 and June 30, 2016 were included.Main outcome and measuresThe association between physician sex and the initiation of a lower than recommended-dose ChEI was examined using generalized linear mixed regression models, adjusting for patient and physician characteristics. Data were stratified by specialty. Secondary analyses explored the association between physician sex and cardiac screening as well as shorter duration of the initial prescription.ResultsThe analysis included 3,443 female and 5,811 male physicians and the majority (83%) were family physicians, Female physicians were more likely to initiate ChEI therapy at a lower-than-recommended dose (Adjusted odds ratio = 1.43,95% confidence interval = 1.17 to 1.74). Compared to their male counterparts, female physicians were also more likely to follow other conservative prescribing practices including cardiac screening (55.1% vs. 49.2%, P-value<0.001) around the time of ChEI initiation, and dispensing a shorter duration of initial prescription (41.8% vs 35.5% P-value<0.001).ConclusionsThere is a statistically significant and important difference in ChEI prescribing patterns between female and male physicians, suggesting that female physicians may be more careful and conservative in their approaches. This will inform future research to determine if patients receiving lower-than-recommended initial doses also have better outcomes.

Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians

“…66,67 Humanistic relationships with patients may enable increased patient disclosure of medical information 65,68 and foster stronger relationships among health team members, thereby improving patient care. Furthermore, female physicians, on average, [51][52][53][54] may obtain more frequent informal consultations with colleagues and be more focused on reading clinical research studies or reviewing a patient's chart when making clinical decisions.…”

The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence

“…[22][23][24] that medical service provision is related to physicians' risk attitudes [30][31][32][33][34][35] and experience. 36,37 Furthermore, the sex of physicians is associated with treatment 36 and prescribing decisions 38 and with patient outcomes. 39,40 Personality traits are also important to explain decisions and behavior in various contexts.…”

Resident-Level Predictors of Dementia Pharmacotherapy at Long-Term Care Admission: The Impact of Different Drug Reimbursement Policies in Ontario and Saskatchewan: Prédicteurs de la pharmacothérapie de la démence au niveau des résidents lors de l’hospitalisation dans des soins de longue durée : l’impact de différentes politiques de remboursement des médicaments en Ontario et en Saskatchewan

“…56 Previous work has shown that physician sex is associated with ChEI prescribing patterns. 57 Other work has shown that physicians are influenced by family wishes when deciding whether to prescribe ChEIs. 58 Further work is required to understand the nonclinical factors that may influence prescribing of dementia pharmacotherapy and whether these vary by region.…”