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CLINICAL STUDIES

Specialty differences in cardiovascular disease prevention practices

^a Health Policy Research and Development Unit, General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA

Manuscript received August 5, 1997; revised manuscript received June 12, 1998, accepted July 17, 1998.

Address for correspondence: Dr. Randall S. Stafford, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, Massachusetts 02114
stafford{at}gem.mgh.harvard.edu

Objectives. The aim of this study was to examine physician specialty differences in cardiovascular disease prevention practices.

Background. Despite the importance of cardiovascular disease prevention, little is known about current national practices, particularly physician specialty differences.

Methods. Using a national survey of office visits, we evaluated differences in the propensity of physicians of different specialties to provide prevention services. We analyzed 30,929 adult visits to 1,521 physicians selected by stratified random sampling in the 1995 National Ambulatory Medical Care Survey. Standard and ordinal multiple logistic regression models were employed to estimate the independent effects of physician and patient characteristics.

Results. A variety of cardiovascular disease prevention services were provided during an estimated 547 million adult office visits to US physicians in 1995, including blood pressure measurement (50% of visits), cholesterol testing (5%) and counseling for exercise (12%), weight (6%), cholesterol (4%) and smoking (3%). In addition, medication management was reflected by the report of antihypertensives in 12% of visits and lipid-lowering medications in 2%. Across these eight services, propensity to provide services varied consistently with specialty. Controlling for patient and visit characteristics and compared to general internists, the likelihood of providing services was higher for cardiologists (adjusted odds ratio 1.65, 95% confidence interval 1.44 to 1.89) but lower for obstetrician/gynecologists (0.75, 0.68 to 0.82), family physicians (0.69, 0.64 to 0.74), general practitioners (0.58, 0.53 to 0.63), other medical specialists (0.65, 0.59 to 0.72) and surgeons (0.06, 0.05 to 0.06).

Conclusions. Cardiologists have the greatest propensity to provide cardiovascular disease prevention services, while primary care physicians vary substantially in their practices. These findings suggest a need to address variations in cardiovascular disease prevention.

Abbreviations and Acronyms   CI = confidence interval   CVD = cardiovascular disease   NAMCS = National Ambulatory Medical Care Survey   OB/GYN = obstetrician/gynecologist   OR = odds ratio

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