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Differences in Outpatient Corticosteroid Prescribing Patterns Between Attending and House Staff Physicians as an Indicator of the Quality of Supervision

Departments of Medicine, Pharmacy, Information Resource Management, and Quality Management at the Department of Veterans Affairs Medical Center, Boston, Mass, and the Boston University School of Medicine, Boston, Mass, jkarlinsky{at}med-medl.bu.edu

Carlos M. Barrera, MD

Departments of Medicine, Pharmacy, Information Resource Management, and Quality Management at the Department of Veterans Affairs Medical Center, Boston, Mass, and the Boston University School of Medicine, Boston, Mass

David M. Goodman, PhD

Departments of Medicine, Pharmacy, Information Resource Management, and Quality Management at the Department of Veterans Affairs Medical Center, Boston, Mass, and the Boston University School of Medicine, Boston, Mass

Martin H. Abramson, MS

Departments of Medicine, Pharmacy, Information Resource Management, and Quality Management at the Department of Veterans Affairs Medical Center, Boston, Mass, and the Boston University School of Medicine, Boston, Mass

James S. Kaufman, MD

Departments of Medicine, Pharmacy, Information Resource Management, and Quality Management at the Department of Veterans Affairs Medical Center, Boston, Mass, and the Boston University School of Medicine, Boston, Mass

Deborah F. Creech, RN, MSM

Departments of Medicine, Pharmacy, Information Resource Management, and Quality Management at the Department of Veterans Affairs Medical Center, Boston, Mass, and the Boston University School of Medicine, Boston, Mass

Computerized information systems have become an in-dispensable source of quality improvement data in the healthcare field. The degree to which we are successful in using these systems is limited only by our ability to ask the right questions. In this study, computerized patient records were used to evaluate the uniformity in the prescribing patterns for oral corticosteroids among house staff and attending physicians as a measure of the adequacy of resident supervision in the outpatient setting. Retrospective analysis of the records of 771 outpatients receiving prescriptions for oral corticosteroid preparations over 1 year in a large tertiary-care university-affiliated Department of Veterans Affairs Medical Center indicated different prescribing patterns for attending physicians and house staff. Additionally, it was noted that house staff tended to manage more complex patients than did attending physicians. We further evaluated the clinical outcomes of these patients to assess the quality, appropriateness, and comparability of care within cohorts of patients and to determine the degree to which resident supervision may have affected outcomes. The study results suggest that there is an opportunity to improve the management of patients treated with oral corticosteroid therapy by increasing staff physician involvement either through direct care of the most complex cases or through enhanced resident supervision.

Key Words: Prescribing behavior • quality of care

American Journal of Medical Quality, Vol. 15, No. 1, 26-33 (2000)
DOI: 10.1177/106286060001500105


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