Several E-druggers have raised doubts about the impact of undergraduate
training on prescribing behavior. It seems reasonable to assume that 5 or 6
years of training in which undergraduates are introduced to clinical
medicine, pharmacology and prescribing is going to have some impact!
However traditional courses have not emphasised the practical aspects of
prescribing and judicious choice of medications, so the concern regarding
whether curricula encourage rational drug use is justified..
We have been carrying out some analyses of Australian data on prescribing by
GPs that suggests that the medical school of graduation has some influence
on prescribing, even many years later. We have obtained data on all
recorded prescribing by full-time Australian GPs for the years 1994 and
1995. These data have been linked with files which contain details on the
demographics of the docs, and their patients, practice location, school and
year of graduation.
A lot of time has been spent developing models to account for the
variability in prescribing rates which (predictably) is very marked. We now
have a fairly robust model (although rather limited because of the nature of
the available data) into which we have entered extra variables relating to
workload and socioeconomic status of the practice location. To our surprise
medical school comes out as a significant factor in all of our analyses of
major classes of drugs, and remains significant no matter what other
adjustments are made. In addition the patterns show some consistency across
the Australian medical schools, and we think that for some drug groups
inferences can be made regarding 'quality'. As the schools themselves have
not been shown the data, or had a chance to comment, it is not possible to
give more detail here.
These data are indirect evidence, but they do suggest that undergraduate
training (or lack of it) may be more important than we thought. We are
currently trying to develop better indicators of quality of prescribing.
This is very difficult because of the lack of data on indications in the
national data-set. However sometimes it appears that the choice of agent
within a therapeutic group can be an indicator of quality of prescribing,
and we are re-running the analyses for some drug groups on this basis. If
anyone has similar experiences or data we would love to hear of them.
David Henry
David Henry,
Discipline of Clinical Pharmacology,
Faculty of Medicine and Health Sciences,
The University of Newcastle,
Newcastle Mater Hospital,
Waratah, NSW, AUSTRALIA
Phone +61 (0)49 211856
Fax +61 (0)49 602088
mddah@alinga.newcastle.edu.au
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