TY - JOUR
T1 - Provider and site-level determinants of testosterone prescribing in the veterans healthcare system
AU - Jasuja, Guneet K.
AU - Bhasin, Shalender
AU - Rose, Adam J.
AU - Reisman, Joel I.
AU - Hanlon, Joseph T.
AU - Miller, Donald R.
AU - Morreale, Anthony P.
AU - Pogach, Leonard M.
AU - Cunningham, Francesca E.
AU - Park, Angela
AU - Wiener, Renda S.
AU - Gifford, Allen L.
AU - Berlowitz, Dan R.
N1 - Publisher Copyright:
Copyright © 2017 Endocrine Society.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85031014052&partnerID=8YFLogxK
U2 - 10.1210/jc.2017-00468
DO - 10.1210/jc.2017-00468
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C2 - 28911150
AN - SCOPUS:85031014052
SN - 0021-972X
VL - 102
SP - 3226
EP - 3233
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 9
ER -