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

Paula A Rochon,Lisa Mccarthy,Colin Faulkner,Peter C Austin,Wei Wu,Rachel Savage,Dallas P Seitz,Lynn Zhu,Vasily Giannakeas,Chaim M Bell,Nathan Herrmann,Nathan M Stall,Jerry H Gurwitz,Sudeep S Gill,Sharon-Lise Normand,Andrea Gruneir,Susan E Bronskill,Danijela Gnjidic

doi:10.1371/journal.pone.0205524

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.

Highlights

A growing body of evidence supports differences in the style of medicine practiced by physicians according to their sex and gender
To explore more careful and conservative prescribing practices between female and male physicians, we examined incident use of cholinesterase inhibitor (ChEI) drug therapy in a population-based cohort of older adults with dementia
At the time of the first ChEI prescription for the patients in the cohort, male physicians had been in practice longer than their female counterparts

Summary

Introduction

A growing body of evidence supports differences in the style of medicine practiced by physicians according to their sex and gender. Evidence suggests that female physicians spend more time with their patients[1], provide more counselling about unhealthy behaviours[2], are more likely to adhere to guidelines[3] and deliver recommended screening[4, 5], and offer more follow-up care[1]. Taken collectively, these differences suggest that female physicians pursue a more careful and conservative approach to patient management. Where possible drug therapy should be initiated in an older individual at a low-dose[13]

Methods

Results

Conclusion