The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing

Jacqueline M Bos; Marijke J C Timmermans; Gerard A Kalkman; Patricia M L A van den Bemt; Peter A G M De Smet; Michel Wensing; Cornelis Kramers; Miranda G H Laurant

doi:10.1371/journal.pone.0202626

The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing

Jacqueline M Bos^*, Marijke J C Timmermans, Gerard A Kalkman, Patricia M L A van den Bemt, Peter A G M De Smet, Michel Wensing, Cornelis Kramers, Miranda G H Laurant

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

AIM: This study determined the effect of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs) on non-adherence to guidelines on medication prescribing.

METHODS: A multicenter matched-controlled study was performed comparing wards on which PAs provide medical care in collaboration with MDs (PA/MD model), with wards on which only MDs provide medical care (MD model). A set of 17 quality indicators to measure non-adherence to guidelines on medication prescribing by PAs and MDs was composed by 14 experts in a modified Delphi procedure. The indicators covered different pharmacotherapeutic subjects, such as gastric protection in case of use of NSAID or prevention of obstipation in case of use of opioids. These indicators were expressed in proportions by dividing the number of patients in which the prescriber did not adhere to a guideline, by all patients that were applicable. Multivariable regression analysis was performed in order to adjust for potential confounders.

RESULTS: 1021 patients from 17 hospital wards in the 'PA/MD model' group and 1286 patients from 17 hospital wards in the 'MD model' group were included. Two of the 17 quality indicators showed significantly less non-adherence to guidelines for the PA/MD model; the indicators concerning prescribing gastric protection in case of use of NSAID in combination with corticosteroids (OR 0.42, 95% CI 0.19-0.90) and in case of use of NSAID in patients older than 70 years (OR 0.47, 95% 0.23-0.95). For none of the other quality indicators for prescribing of medication a difference between the MD model and the PA/MD model was found.

CONCLUSION: This study suggests that the non-adherence to guidelines on medication prescribing on wards with the PA/MD model does not differ from wards with traditional house staffing by MDs only. Further research is needed to determine quality, efficiency and safety of prescribing behavior of PAs.

Original language	English
Article number	e0202626
Number of pages	13
Journal	PLoS ONE
Volume	13
Issue number	8
DOIs	https://doi.org/10.1371/journal.pone.0202626
Publication status	Published - 2018
Externally published	Yes

Keywords

Aged
Aged, 80 and over
Analgesics, Opioid/therapeutic use
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Drug Prescriptions
Female
Guidelines as Topic
Hospitalization
Hospitals
Humans
Inpatients
Male
Patient Care Team
Patients' Rooms
Physician Assistants
Physicians

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Bos, J. M., Timmermans, M. J. C., Kalkman, G. A., van den Bemt, P. M. L. A., De Smet, P. A. G. M., Wensing, M., Kramers, C., & Laurant, M. G. H. (2018). The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing. PLoS ONE, 13(8), Article e0202626. https://doi.org/10.1371/journal.pone.0202626

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abstract = "AIM: This study determined the effect of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs) on non-adherence to guidelines on medication prescribing.METHODS: A multicenter matched-controlled study was performed comparing wards on which PAs provide medical care in collaboration with MDs (PA/MD model), with wards on which only MDs provide medical care (MD model). A set of 17 quality indicators to measure non-adherence to guidelines on medication prescribing by PAs and MDs was composed by 14 experts in a modified Delphi procedure. The indicators covered different pharmacotherapeutic subjects, such as gastric protection in case of use of NSAID or prevention of obstipation in case of use of opioids. These indicators were expressed in proportions by dividing the number of patients in which the prescriber did not adhere to a guideline, by all patients that were applicable. Multivariable regression analysis was performed in order to adjust for potential confounders.RESULTS: 1021 patients from 17 hospital wards in the 'PA/MD model' group and 1286 patients from 17 hospital wards in the 'MD model' group were included. Two of the 17 quality indicators showed significantly less non-adherence to guidelines for the PA/MD model; the indicators concerning prescribing gastric protection in case of use of NSAID in combination with corticosteroids (OR 0.42, 95% CI 0.19-0.90) and in case of use of NSAID in patients older than 70 years (OR 0.47, 95% 0.23-0.95). For none of the other quality indicators for prescribing of medication a difference between the MD model and the PA/MD model was found.CONCLUSION: This study suggests that the non-adherence to guidelines on medication prescribing on wards with the PA/MD model does not differ from wards with traditional house staffing by MDs only. Further research is needed to determine quality, efficiency and safety of prescribing behavior of PAs.",

keywords = "Aged, Aged, 80 and over, Analgesics, Opioid/therapeutic use, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Drug Prescriptions, Female, Guidelines as Topic, Hospitalization, Hospitals, Humans, Inpatients, Male, Patient Care Team, Patients' Rooms, Physician Assistants, Physicians",

author = "Bos, {Jacqueline M} and Timmermans, {Marijke J C} and Kalkman, {Gerard A} and {van den Bemt}, {Patricia M L A} and {De Smet}, {Peter A G M} and Michel Wensing and Cornelis Kramers and Laurant, {Miranda G H}",

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T1 - The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing

AU - Bos, Jacqueline M

AU - Timmermans, Marijke J C

AU - Kalkman, Gerard A

AU - van den Bemt, Patricia M L A

AU - De Smet, Peter A G M

AU - Wensing, Michel

AU - Kramers, Cornelis

AU - Laurant, Miranda G H

PY - 2018

Y1 - 2018

N2 - AIM: This study determined the effect of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs) on non-adherence to guidelines on medication prescribing.METHODS: A multicenter matched-controlled study was performed comparing wards on which PAs provide medical care in collaboration with MDs (PA/MD model), with wards on which only MDs provide medical care (MD model). A set of 17 quality indicators to measure non-adherence to guidelines on medication prescribing by PAs and MDs was composed by 14 experts in a modified Delphi procedure. The indicators covered different pharmacotherapeutic subjects, such as gastric protection in case of use of NSAID or prevention of obstipation in case of use of opioids. These indicators were expressed in proportions by dividing the number of patients in which the prescriber did not adhere to a guideline, by all patients that were applicable. Multivariable regression analysis was performed in order to adjust for potential confounders.RESULTS: 1021 patients from 17 hospital wards in the 'PA/MD model' group and 1286 patients from 17 hospital wards in the 'MD model' group were included. Two of the 17 quality indicators showed significantly less non-adherence to guidelines for the PA/MD model; the indicators concerning prescribing gastric protection in case of use of NSAID in combination with corticosteroids (OR 0.42, 95% CI 0.19-0.90) and in case of use of NSAID in patients older than 70 years (OR 0.47, 95% 0.23-0.95). For none of the other quality indicators for prescribing of medication a difference between the MD model and the PA/MD model was found.CONCLUSION: This study suggests that the non-adherence to guidelines on medication prescribing on wards with the PA/MD model does not differ from wards with traditional house staffing by MDs only. Further research is needed to determine quality, efficiency and safety of prescribing behavior of PAs.

AB - AIM: This study determined the effect of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs) on non-adherence to guidelines on medication prescribing.METHODS: A multicenter matched-controlled study was performed comparing wards on which PAs provide medical care in collaboration with MDs (PA/MD model), with wards on which only MDs provide medical care (MD model). A set of 17 quality indicators to measure non-adherence to guidelines on medication prescribing by PAs and MDs was composed by 14 experts in a modified Delphi procedure. The indicators covered different pharmacotherapeutic subjects, such as gastric protection in case of use of NSAID or prevention of obstipation in case of use of opioids. These indicators were expressed in proportions by dividing the number of patients in which the prescriber did not adhere to a guideline, by all patients that were applicable. Multivariable regression analysis was performed in order to adjust for potential confounders.RESULTS: 1021 patients from 17 hospital wards in the 'PA/MD model' group and 1286 patients from 17 hospital wards in the 'MD model' group were included. Two of the 17 quality indicators showed significantly less non-adherence to guidelines for the PA/MD model; the indicators concerning prescribing gastric protection in case of use of NSAID in combination with corticosteroids (OR 0.42, 95% CI 0.19-0.90) and in case of use of NSAID in patients older than 70 years (OR 0.47, 95% 0.23-0.95). For none of the other quality indicators for prescribing of medication a difference between the MD model and the PA/MD model was found.CONCLUSION: This study suggests that the non-adherence to guidelines on medication prescribing on wards with the PA/MD model does not differ from wards with traditional house staffing by MDs only. Further research is needed to determine quality, efficiency and safety of prescribing behavior of PAs.

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KW - Aged, 80 and over

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KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use

KW - Drug Prescriptions

KW - Female

KW - Guidelines as Topic

KW - Hospitalization

KW - Hospitals

KW - Humans

KW - Inpatients

KW - Male

KW - Patient Care Team

KW - Patients' Rooms

KW - Physician Assistants

KW - Physicians

U2 - 10.1371/journal.pone.0202626

DO - 10.1371/journal.pone.0202626

M3 - Article

C2 - 30138432

SN - 1932-6203

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JO - PLoS ONE

JF - PLoS ONE

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