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(Circulation. 2008;117:623-628.)
© 2008 American Heart Association, Inc.

Health Services and Outcomes Research

Effect of Board Certification on Antihypertensive Treatment Intensification in Patients With Diabetes Mellitus

Alexander Turchin, MD, MS; Maria Shubina, DSc; Anna H. Chodos, BA; Jonathan S. Einbinder, MD, MPH; Merri L. Pendergrass, MD, PhD

From the Division of Endocrinology (A.T., M.L.P.), Center for Clinical Investigation (M.S.), and Division of General Medicine (J.S.E.), Brigham and Women’s Hospital; Harvard Medical School (A.T., A.H.C., J.S.E., M.L.P.); and Clinical Informatics Research and Development, Partners HealthCare System (A.T., J.S.E.), Boston, Mass.

Reprint requests to Alexander Turchin, MD, MS, Division of Endocrinology, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115. E-mail aturchin{at}partners.org

Received August 13, 2007; accepted November 27, 2007.

Background— Regular recertification is mandatory to maintain board certification status in all specialties. However, the evidence that physicians’ performance decreases with time since initial certification is limited. We therefore carried out a study to determine whether the frequency of antihypertensive treatment intensification for diabetic patients changes with time since their physicians’ last board certification.

Methods and Results— In this retrospective cohort study, we analyzed treatment of 8127 hypertensive patients with diabetes mellitus treated by 301 internists at primary care practices affiliated with 2 large academic hospitals. Patient visits with documented blood pressure 130/85 mm Hg between January 1, 2000, and August 31, 2005, were studied. The association between the number of years since the physician’s last board certification and the probability of pharmacological antihypertensive treatment intensification at a given visit was analyzed. Frequency of treatment intensification decreased from 26.7% for physicians who were board certified the previous year to 6.9% for physicians who were board certified 31 years before the visit. Treatment intensification rate was 22.5% for physicians certified 10 years ago versus 16.9% for physicians last certified >10 years ago (P<0.0001). Multivariable analysis adjusted for patient and visit characteristics and physician age showed that for every decade since the physician’s last board certification, the probability of treatment intensification decreased by 21.3% (P=0.0097).

Conclusion— Physician intensification of pharmacological therapy for blood pressure levels above the recommended treatment goals decreases with time since the last board certification. This finding supports the current policy of mandatory recertification.

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