Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System
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 were more…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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