Providers and policymakers all know about geographic variation in healthcare spending, but a new report reveals great disparity in the frequency with which doctors make medical errors in prescribing inappropriate, potentially harmful medications to people over age 65.
A research perspective in the New England Journal of Medicine dissects two categories of prescribing practices in 2007 for each of 306 Dartmouth Atlas referral regions in the country.
"We have long known that the quality of prescribing drugs is definitely not optimal everywhere." says study author Yuting Zhang, professor of health policy and management at the University of Pittsburgh. "But this study demonstrates how big the problem is, and how much (practice habits) are different from one part of the country to another."
Zhang added that while she doesn't know why some doctors in some parts of the country are less likely to adhere to the guidelines, she postulated that "perhaps some of them don't know about the guidelines" or that the drugs are contraindicated in people over 65.
The first category of the study details the rate at which doctors prescribe drugs considered high risk for elderly patients and which should be avoided in seniors.
Zhang says that doctors serving Medicare beneficiaries in Bronx, NY and White Plains, NY had the best prescribing practices, in that they had the lowest rates of prescribing at least one drug that is hazardous when used in the elderly. Examples of such drugs include certain antihistamines, long-acting benzodiazepines, thioridazine, and some skeletal muscle relaxants.
The two regions of the country that had the worst rates of high-risk drug prescribing practices were Alexandria, LA and Wichita Falls, TX.