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

• DOI: 10.1371/journal.pone.0205524
• Publication Date: 2018-10-22T20:05:01Z
• Authors: Paula A. Rochon; Andrea Gruneir; Chaim M. Bell; Rachel Savage; Sudeep S. Gill; Wei Wu; Vasily Giannakeas; Nathan M. Stall; Dallas P. Seitz; Sharon-Lise Normand; Lynn Zhu; Nathan Herrmann; Lisa McCarthy; Colin Faulkner; Jerry H. Gurwitz; Peter C. Austin; Susan E. Bronskill
• Keywords: Adult; Male; Science; Therapeutics; Conservative Treatment; Time-to-Treatment; 03 medical and health sciences; Elderly; Risk-Taking; Sex Factors; 0302 clinical medicine; Geriatric psychiatry; Physicians; Humans; Practice Patterns, Physicians'; Health Services Administration; Aged; Retrospective Studies; Aged, 80 and over; Ontario; Q; R; Cholinesterase inhibitors; Middle Aged; 3. Good health; Pharmaceutical Preparations; Geriatrics; Adverse events; Medicine; Dementia; Female; Drug therapy; Health Services Research; Cholinesterase Inhibitors; Research Article; Specialization

Subtle 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.To 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.All 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.The 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.The 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).There 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.