Characteristics and quality of prescribing by doctors practicing in nursing homes

To describe the professional characteristics of doctors practicing in nursing homes and to determine whether those characteristics correlate with quality of prescribing.

A prospective, cohort study.

306 physicians practicing in 12 nursing homes in greater Los Angeles.

We surveyed doctors about their age, sex, education, credentials, and NH practice. We also determined medication orders for a 1-month period and evaluated them using explicit criteria for appropriateness developed by an expert panel.

We obtained data from 72% of MDs. Respondents had a mean age of 53 years (29-78) and were 94% male. Fifty-seven percent trained in internal medicine, 20% graduated outside the US or Canada, 67% were board certified in their declared specialty, and 5% had a certificate of added qualification in geriatrics (CAQ). Sixteen percent spent > 10% of their professional time in NHs, and 46% had NH practices that were > 20% Medicaid; most did not consult psychiatrists when prescribing psychoactive drugs. Forty percent of residents had at least one inappropriate prescription. The characteristics of doctors associated with the best prescribing quartile were female sex, CAQ, no board certification, and frequent consultation with psychiatrists. The characteristics of doctors in the most inappropriate quartile were older age, graduation from medical school before 1965, graduation from US medical school, small NH practice, and infrequent consultation with psychiatrists.

Although the quality of prescribing in nursing homes is related to some physician characteristics, the relationships are not those most commonly stated.