Provider and site-level determinants of testosterone prescribing in the veterans healthcare system

Guneet K. Jasuja*, Shalender Bhasin, Adam J. Rose, Joel I. Reisman, Joseph T. Hanlon, Donald R. Miller, Anthony P. Morreale, Leonard M. Pogach, Francesca E. Cunningham, Angela Park, Renda S. Wiener, Allen L. Gifford, Dan R. Berlowitz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Context: Testosterone prescribing rates have increased substantially in the past decade. However, little is known about the context within which such prescriptions occur. Objective: We evaluated provider- and site-level determinants of receipt of testosterone and of guideline-concordant testosterone prescribing. Design: This study was cross-sectional in design. Setting: This study was conducted at the Veterans Health Administration (VA). Participants: Study participants were a national cohort of male patients who had received at least one outpatient prescription within the VA during fiscal year (FY) 2008 to FY 2012. A total of 38,648 providers and 130 stations were associated with these patients. Main Outcome Measure: This study measured receipt of testosterone and guideline-concordant testosterone prescribing. Results: Providers ranging in age from 31 to 60 years, with less experience in the VA [all adjusted odds ratio (AOR),2; P,0.01] and credentialed as medical doctors in endocrinology (AOR, 3.88; P, 0.01) and urology (AOR, 1.48; P , 0.01) were more likely to prescribe testosterone compared with older providers, providers of longer VA tenure, and primary care providers, respectively. Sites located in the West compared with the Northeast [AOR, 1.75; 95% confidence interval (CI), 1.45-2.11] and care received at a community-based outpatient clinic compared with a medical center (AOR, 1.22; 95% CI, 1.20-1.24) also predicted testosterone use. Although they weremorelikely to prescribe testosterone, endocrinologists were also more likely to obtain an appropriate workup before prescribing compared with primary care providers (AOR, 2.14; 95% CI, 1.54-2.97). Conclusions: Our results highlight the opportunity to intervene at both the provider and the site levels to improve testosterone prescribing. This study also provides a useful example of how to examine contributions to prescribing variation at different levels of the health care system.

Original languageAmerican English
Pages (from-to)3226-3233
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number9
DOIs
StatePublished - 1 Sep 2017
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. Dr. Jasuja is a VA HSR&D Career Development awardee at the Bedford VA (CDA 13-265). The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

Publisher Copyright:
Copyright © 2017 Endocrine Society.

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