Physician Behavior Research Articles

Opioid prescriptions following behavioral health training among primary care providers

BackgroundOverdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians.MethodsWe retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider’s TNT “treatment” if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification.ResultsPost-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p < 0.001) as well as after clustering patient observations by provider.ConclusionIn a large Southern California healthcare system, the TNT training program preceded a reduction in primary care providers’ prescription rates of opioids. If replicated in larger samples, a low-cost provider training program has the potential to promote more judicious use of opioids for pain management. We encourage more studies to understand the program’s long-term impact on physician behavior and, potentially, on patient outcomes.

Demonstration of the Clinical Utility of a Psoriasis Precision Medicine Tool: Findings from the MATCH Study Show Altered Physician Behavior Leads to Improved Patient Outcomes

Demonstration of the Clinical Utility of a Psoriasis Precision Medicine Tool: Findings from the MATCH Study Show Altered Physician Behavior Leads to Improved Patient Outcomes

Physician's prescription and pharmaceutical industry's influence - where have the ethics gone?

The relationship between physicians and the pharmaceutical industry has evolved significantly over the years, raising concerns about ethical practices in medical prescribing. This article explores the multifaceted influence of pharmaceutical companies on physician behaviour, highlighting how marketing strategies, financial incentives, and promotional activities can compromise the integrity of clinical decision-making. Through a comprehensive review of the literature, the article examines the implications of inculcating ethics in undergraduate medical programmes, so future healthcare professionals understand the importance of making evidence-based decisions. Furthermore, this article calls for a critical evaluation of existing regulatory frameworks and advocates for stronger ethical guidelines to ensure that physician prescriptions are based solely on patient needs rather than external pressures from the pharmaceutical industry. Ultimately, it emphasizes the importance of restoring ethical standards in medicine to safeguard patient welfare and maintain the sanctity of the physician-patient relationship. Keywords: Physician’s prescription, pharmaceutical industry, Ethics.

Development and validation of the chronic condition physician-patient relationship scale (CC-PPR): A patient-informed measurement tool

ObjectiveSeveral tools exist to measure the physician-patient relationship; however few are specific to those with chronic physical health conditions, and none to date have been derived from the patient’s perspective. This research aimed to develop and validate a patient-informed tool for measuring the physician-patient relationship with patients who have a chronic physical health condition. MethodsStudy 1: An Australian sample of participants with a diagnosed chronic physical health condition and a self-reported good physician-patient relationship completed a three round Delphi poll to determine items of the chronic condition physician-patient relationship scale (CC-PPR). Fifty-two participants completed round one, 33 completed round two, and 24 completed all three rounds. Study 2: Exploratory and confirmatory factor analysis were conducted on a separate sample (N = 226) to explore the factor structure of the CC-PPR. ResultsThe CC-PPR comprised 22 items within a single-factor structure which demonstrated high internal consistency (Cronbach’s α = 0.97) and sound convergent validity. DiscussionThe CC-PPR reliably measures observable, concrete, and specific physician behaviours that patients with chronic physical health conditions believe are critical in forming a good physician-patient relationship. The CC-PPR has potential application in research, educational, and self-assessment contexts, including for the evaluation and development of competence in post-graduate and professional settings.

Application of clinical thinking training system based on entrustable professional activities in emergency teaching

BackgroundStandardized training for resident physicians (STRP) is essential for improving their clinical skills. The standardized training for resident physicians in emergency medicine differs from other disciplines, focusing more on knowledge related to medical emergencies and emergency care skills requiring urgency and real-time response. There are specific differences in knowledge content, teaching methods, curriculum design, and career development compared to other specialties. As a national-level teaching base for emergency medicine, our hospital continuously explores and innovates in teaching models, discovering a model more suitable for emergency medicine.ObjectiveThis study summarizes practical experience in teaching and assessment integration (TAA), evaluates teaching training effectiveness with the Clinical Thinking Training System (CTTS), and examines integrating this system with innovative teaching and assessment models' impact on resident physicians' clinical abilities.MethodsIn our study, we selected residents who rotated in our department from July-December 2023 and randomly divided them into a reform group (n = 106) and a control group (n = 104). The reform group received training using the Clinical Thinking Training System (CTTS) while the control group received standard training consistent with the existing STRP framework. We integrate innovative teaching and assessment (TAA) models and the Entrustable Professional Activities (EPAs) scale to assess students' abilities, stratifying by grade level, background, and major to evaluate students' departmental rotation examination (DRE) and EPAs scores.ResultThe DRE scores and Mini-CEX scores were significantly higher in the reformed group compared to the control group. The final assessments showed the reform group scored significantly higher in first-case documentation and overall clinical thinking decision-making. Specifically, the reform group had significantly higher scores in first-case documentation for second-year, third-year, undergraduate, and graduate students, and non-emergency specialty students. The clinical thinking decision-making scores of the reform group were significantly higher across different years, specialties, and educational backgrounds. All the EPAs results indicated the CTTS improved treatment decision-making abilities among students with different years of training, educational backgrounds, and specialties. Moreover, the ability for continuous patient management improved to some extent among students in different years and with different educational backgrounds.ConclusionThe integration of innovative teaching and assessment models with the CTTS is more conducive to improving the examination performance and confidence in professional behavior of resident physicians.

Commercial prices and their influence on urology practices: Prostate cancer care among men with Medicare.

For men with prostate cancer, there is substantial variation in the use of conservative management, such as active surveillance. Commercial prices, which vary across urology practices, may afford incentives that foster physician behaviors associated with utilization. Such behaviors may "spillover" to the Medicare population and affect quality. This study evaluated the effects of practice-level commercial prices on health care utilization and quality in men with prostate cancer insured by traditional Medicare. From a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer between 2014-2019 (n=44,653). Using commercial payments from the MarketScan database, they developed a practice-level commercial price index (ratio of commercial prices to Medicare prices). They examined the association of the price index with price standardized spending, overtreatment (treatment among those with >50% noncancer mortality within 10 years), and underuse of diagnostic testing in active surveillance (at least one prostate-specific antigen test and one confirmatory test-MRI, prostate biopsy, genomic test-within 12 months of diagnosis). Practice-level commercial price indices varied from 1.34 (134% of Medicare prices), for practices in the bottom decile, to 3.00, for practices in the top decile. Increasing price index was associated with lower odds of overtreatment (odds ratio, 0.86; 95% confidence interval, 0.76-0.97; p=.01), but not price standardized spending or underuse of diagnostic testing in active surveillance. Commercial prices vary markedly across urology practices. Among newly diagnosed men with traditional Medicare, those managed by practices with higher commercial price indices had lower odds of overtreatment, suggesting improved prostate cancer care quality.

Workplace violence as a predictor of suicidal ideation in undergraduate internal physicians

The environments in which doctors in training operate have been distinguished by being rigid, hostile and routine. There is scientific evidence that people who are victims of workplace violence are more likely to suffer from depression, a disorder that has been associated with suicidal ideation. To predict suicidal ideation as a function of depressive symptoms and workplace violence in undergraduate internal physicians. The quantitative method was used through a non-experimental, cross-sectional, explanatory design with non-probabilistic convenience sampling. 117 medical students who were doing their internship in health centers in Sonora, Mexico participated. Participants responded to the Workplace Violence Scale (Mobbing), the Beck Depression Inventory, and the Beck Suicidal Ideation Scale. A high perception of workplace violence, moderate levels of depression and low levels of suicidal ideation were identified; Workplace violence was positively and significantly associated with depression and suicidal behavior. Furthermore, it was found that violence provides more explanation for suicidal behavior compared to depression. The predictive role of workplace violence in the suicidal behavior of undergraduate internal physicians is confirmed. Highlights the importance of developing prevention and intervention programs to reduce workplace violence in medical training environments.

Cross-sectional assessment of perception and attitude of pharmacy students towards pharmaceutical promotion: a study from developing country, Pakistan.

The pharmaceutical promotion is "all informational and persuasive activities by manufacturers and distributors, the effect of which is to induce the prescription, supply, purchase and/or use of medicinal drugs. These promotional activities affect the dispensing behavior of physicians and pharmacists and influence begins from educational institutes. Our study's main aim was to evaluate opinion and attitude of pharmacy students towards pharmaceutical promotion. A cross-sectional online survey was conducted among 3rd, 4th and final year pharmacy students of 3 public and 3 private sector universities in Punjab Pakistan. A modified version of pre available questionnaire was used to collect data from students between June 2020 and December 2020. The tool was made available through a Google Form, assessable to students via provided link. We utilized the snowball sampling technique. Descriptive statistics were used to evaluate the demographics, while Chi-square and t-test were used to analyze associations between demographics and items. Data were analyzed using SPSS version 21.0. A total of 1,195 students participated in the survey with an average age of 22.2 ± 1.2 years. Nearly 2/3rd of the students were males (62.2%) and a significant proportion (87.3%) of pharmacy students had never taken part in any training provided by pharmaceutical company. Among all, 51.9% confirmed that pharmacists who frequently interact with medical representatives tend to dispense more antibiotics. Additionally, 42.1% indicated they may dispense antibiotics under the influence of promotion. Pharmacy students in senior college years and those with lower parental exhibited significantly more perception and attitude scores (p < 0.001). A significant number of students concurred with the notion that promotional activities could impact dispensing practices and they also believed that such activities contribute to the growing issue of irrational antibiotic use. This study underscores the necessity for a heightened emphasis on the educational needs of pharmacy students.

Determining factors affecting mother's behaviour in stunting prevention in rural Madura, Indonesia

Stunting is one of the consequences of chronic malnutrition whose prevalence continues to increase in Indonesia. This study used an observational analytical approach to develop a model of mother behaviour in stunting prevention in children. The population consisted of 215 mothers who had children aged 0-24 months. The variables included assessment of behavioural beliefs, behaviour outcomes, attitudes, demographics, perceived control, and intentions. The SEM - smartPLS4 was used for the analysis. The validity test results indicate that the values for Cronbach's alpha and Composite Reliability (C.R) are above 0.7, and the value for Average Variance Extracted (AVE) is above 0.50, indicating that all indicators are valid and reliable. The results revealed that a mother’s behaviour in stunting prevention is directly influenced by her intention, whereas mother's intentions are influenced by attitudes, demography, and perceived control. We conclude that a mother who has high intentions to prevent stunting will be able to practice it because of having a positive attitude and a good perceived control. Behavioural intentions have been identified as the mediating variable of the transformation of behavioural attitudes into treatment, which is consistent with the TPB theory and other research on physician behaviour. In other words, intent can serve not only as an internal driving process of attitude, but also as a condition of preparation for behaviour.

Unveiling the Gaps: Analyzing Family Physicians' Perspectives on Infectious Disease Notification in Türkiye.

This study aimed to assess the opinions, attitudes, and behaviors of family physicians in Türkiye regarding mandatory communicable disease notification. Cross-sectional study. A national online survey in Türkiye. This study was conducted among 397 family physicians from different geographical regions in Türkiye. Family physicians' opinions, attitudes, and behaviors regarding infectious disease notification. The majority of family physicians (69.3%) felt inadequate in terms of knowledge about the notification system and 70.3% desired post-graduation training on communicable disease reporting. About one-third of the participants were dissatisfied with the current notification system. Reasons for under-reporting included lack of time, lack of feedback, and uncertainty about post-notification procedures. Factors significantly associated with higher infectious disease notification attitude scores (IDNAS) were receiving training on communicable disease reporting, feeling competent about reporting, and being satisfied with the reporting system (P <.001). However, physicians who admitted choosing a different ICD code to avoid filling out an infectious disease notification form had lower IDNAS scores (P <.001). This study highlights knowledge gaps and negative attitudes among family physicians in Türkiye regarding infectious disease reporting. Addressing these challenges requires continuous education and training programs. Feedback mechanisms should be improved to enhance physicians' engagement in the notification process. Reducing the workload of family physicians and simplifying the reporting process may also contribute to higher compliance with mandatory communicable disease reporting.

Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach.

Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Physicians estimated that they prescribed antibiotics for 54.8% (9896/18,049) of weekly outpatient encounters, and 178 (96.2%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ≤30 years were less likely to prescribe antibiotics (48/100, 48%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47%) for patients who presented with a URTI than residents (51/100, 51%; P=.03). Similarly, during outpatient visits, physicians ≤30 years old were less likely to prescribe antibiotics (54/100, 54%) than physicians older than 30 years (57/100, 57%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53%) than female physicians (64/100, 64%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53%) than residents (57/100, 57%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital.

Prescriber Phenotypes: Variability in Topical Rosacea Treatment Patterns among United States Dermatologists

Background/Objectives: Aggregate prescribing behavior for inflammatory lesions of rosacea has been described, but individual physician behavior has not been characterized. This study aims to assess the modern state of topical rosacea drug selection by analyzing prescribing patterns among individual dermatologists. Methods: We assessed utilization patterns of four topical papulopustular rosacea agents in 2021 Medicare Part-D data. K-means cluster analysis identified prescriber phenotypes based on the proportion of claims for each drug by physician. Results: Cluster analysis identified four prescriber phenotypes for topical rosacea agents, with the majority favoring metronidazole. In each of the other clusters, metronidazole was co-prescribed alongside the primary agent. Significant predictors of phenotype included patient ages, patient risk scores, and a group practice setting. Conclusions: The study reveals nonuniform prescribing patterns for topical papulopustular rosacea treatments among U.S. dermatologists. While aggregate data indicate diverse drug utilization, cluster analysis suggests that individual prescribers tend to use a limited selection of agents.

Impact analysis of the driver's license-type scoring system in the quality management of hospital medical records: An observational study.

The purpose of this study was to analyze the impact of implementing a driver's license-type scoring system on the quality management of hospital medical records. We collected relevant medical record quality control data before (from April to November 2021) and after (from April to November 2022) the use of the driver's license-type scoring management in the medical record quality management of a Grade-A tertiary general hospital in a prefecture-level city ("R Hospital" for short). We evaluated the impact by statistically analyzing the data using the χ2 test and t test with the SPSSAU online statistical analysis software. Compared with before the implementation of the new system, the filling rate of discharge medical records within 2 days, logical rate of day diagnosis and treatment medical records, logical rate of day surgery medical records, and clinical tumor-node-metastasis staging evaluation rate before tumor treatment significantly increased, and the difference was statistically significant (P < .05); the rate of errors or omissions on the first page of inpatient medical records significantly decreased, and the difference between before and after implementation of the new system was statistically significant (P < .05). We found that the driver's license-type scoring management adapted for use in the quality management of hospital medical records was effective in regulating the medical record writing behavior of physicians and improved the quality of medical records, thus meriting wide promotion.

Qualitative Analysis of Patients' and Physicians' Attitudes and Behaviors Toward Billing Patient Portal Messages.

Qualitative Analysis of Patients' and Physicians' Attitudes and Behaviors Toward Billing Patient Portal Messages.

Ishāq bin Ali al-Ruhawi, a pioneer in medical professionalism in the 9th century AD.

Professionalism and medical ethics, while similar, are often viewed in different contexts. An historical and social science analysis reveals that professionalism is a complex skill that can be developed over time. The key components of professionalism, as defined by the American Physical Therapy Association, include accountability, altruism, compassion, excellence, integrity, professional duty, and social responsibility. Throughout history, physicians have been concerned with medical ethics and professionalism. In the Golden Age of Islam, principles such as excellence, honour, integrity, accountability, and duty were important in shaping the professional behavior of physicians. Adab al-Tabib, an ancient work, by Ishāq bin Ali al-Ruhawi focuses on ethical guidelines and teachings related to medical ethics in the Islamic civilization. Many of the ethical issues in this book are of foremost importance as components of professionalism. However while the examples of medical ethics guidelines that pre-existed Adab al-Tabib such as the Hippocratic Oath, are not mentioned. As one of the first statutes of medical ethics in Islamic civilization, Ruhawi is a model for many doctors in the Golden Age of Islam, and over the years his principles have greatly influenced the professional view of physicians.

AOA Critical Issues Symposium: The Disruptive Physician: Bad Apple or Toxic Tree?

Disruptive physician behavior has become a common problem in medicine. Individuals who conduct themselves in a manner that could negatively affect patient care, or "disruptive physicians," frequently cause stress for patients and staff, are a headache for leadership, and can require expensive remediation. We suggest that rather than "bad apples," many disruptive physicians are the fruit of a "toxic tree." That is, many physicians only become disruptive as a response to their environment. It is important for leaders to accurately identify the root causes of disruptive behavior in order to address the problem. In general, it is important for leaders to act prospectively, to examine events from all perspectives, to promote wellness and communication, and to identify external or systemic causes. We also discuss additional considerations for when the physician who has been labeled "disruptive" is a member of an underrepresented group (in orthopaedic surgery, the underrepresented groups are women and racial minorities). As a conclusion, we offer a case example of how 1 institution established a system of physician wellness to enhance prevention efforts.

Association of the belief in conspiracy narratives with vaccination status and recommendation behaviours of German physicians

Vaccine hesitancy has been identified as one of the top ten threats to global health by the World Health Organization (WHO). The belief in conspiracy narratives is repeatedly discussed as a major driver of vaccine hesitancy among the general population. However, there is a lack of research investigating the role of the belief in conspiracy narratives in vaccination decisions and recommendation behaviours of physicians. This is particularly relevant as physicians are one of the major and trusted sources of information for patients’ vaccination decisions. This study therefore investigated the association between believing in COVID-19-related conspiracy narratives and physicians’ own COVID-19 vaccination status and their recommendation behavior for COVID-19 and other vaccines (e.g., HPV or flu). In a cross-sectional survey among German physicians (N = 602, April 2022) two conspiracy narratives were assessed, stating that the coronavirus is a hoax or that it is human-made. Additional control variables included trust in health institutions, the rejection of complementary and alternative medicine (CAM), the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, and collective responsibility) and demographic variables. Hierarchical regressions indicated that greater belief in the conspiracy narrative claiming that the coronavirus is a hoax was associated with lower COVID-19 vaccination uptake and fewer COVID-19 vaccination recommendations among physicians. The results for recommendation behavior remain robust even when controlling for other variables. Contrary to our assumption, believing that the coronavirus is human-made was not related to vaccination status nor vaccine recommendation behavior. In conclusion, believing in conspiracy narratives that question the existence and thus also the danger of the virus is an important independent predictor of vaccine hesitancy among physicians that should be addressed in future public health interventions.

Evaluation of Pharmaceutical Marketing Tools and Their Influence on Prescribing Behavior of Physicians in Brazil: A Mixed-Method Study

Evaluation of Pharmaceutical Marketing Tools and Their Influence on Prescribing Behavior of Physicians in Brazil: A Mixed-Method Study

Controlling Prescribing through "Preferred Drug" Targets-The Bavarian Experience.

The rising costs of drugs are putting health care systems under pressure. We report on the Bavarian Drug Agreement, which employs prescribing targets for preferred and generic drugs in ambulatory care. Under this agreement, providers are regularly profiled with individual feedback but also possible sanctions. We investigated the degree to which targets were being met (or not) and why failure occurred. We analysed prescribing data aggregated by practice for the quarter 1/2018. We chose eight specialisation groups and analysed their drug targets with a high prescribing volume, widely missed drug targets (<90%), and drugs preventing drug target achievement. Characterisation of drug targets and preventing drugs was undertaken. Drug targets with a high prescribing volume are mostly achieved, while highly missed drug targets mostly do not affect the main indication area of the specialisation groups considered. Generic drug targets seem to be more easily achieved than recommended drug targets. Paediatrics accounts for the largest number of missed drug targets. The Bavarian tool implemented uses the prescribing volume (DDD) and price components to evaluate the prescription behaviour of physicians. Well-established drugs with demonstrated effectiveness, safety, and lower costs are preferred. Nevertheless, me-too drugs, combination drugs, costly innovations with unclear value, and drugs with application methods of variable convenience challenge the drug prescribers and are reasons for missed drug targets.

What Constitutes High Risk for Venous Thromboembolism? Comparing Approaches to Determining an Appropriate Threshold.

Guidelines recommend pharmacological venous thromboembolism (VTE) prophylaxis only for high-risk patients, but the probability of VTE considered "high-risk" is not specified. Our objective was to define an appropriate probability threshold (or range) for VTE risk stratification and corresponding prophylaxis in medical inpatients. Patients were adults admitted to any of 10 Cleveland Clinic Health System hospitals between December 2020 and August 2021 (N = 41,036). Hospital medicine physicians and internal medicine residents from included hospitals were surveyed between June and November 2023 (N = 214). We compared five approaches to determining a threshold: decision analysis, maximizing the sensitivity and specificity of a logistic regression model, deriving a probability from a point-based model, surveying physicians' understanding of VTE risk, and deriving a probability from physician behavior. For each approach, we determined the probability threshold above which a patient would be considered high-risk for VTE. We applied each threshold to the Cleveland Clinic VTE risk assessment model (CCM) and calculated the percentage of the 41,036 patients in our cohort who would be considered eligible for prophylaxis due to their high-risk status. We compared these hypothetical prophylaxis rates with physicians' observed prophylaxis rates. The different approaches yielded thresholds ranging from 0.3% to 5.4%, corresponding inversely with hypothetical prophylaxis rates of 0.2% to 75%. Multiple thresholds clustered between 0.52% to 0.55%, suggesting an average hypothetical prophylaxis rate of approximately 30%, whereas physicians' observed prophylaxis rates ranged from 48% to 76%. Multiple approaches to determining a probability threshold for VTE prophylaxis converged to suggest an optimal threshold of approximately 0.5%. Other approaches yielded extreme thresholds that are unrealistic for clinical practice. Physicians prescribed prophylaxis much more frequently than the suggested rate of 30%, indicating opportunity to reduce unnecessary prophylaxis. To aid in these efforts, guidelines should explicitly quantify high-risk.