Study supports periodic re-certification for doctors

NEW YORK (Reuters Health) - The time elapsed since a primary care physician's last board certification correlates with a decline in the quality of care provided to patients, according to a study published today.

Since 2006, specialty boards have required periodic re-certification for physicians to maintain their credentials, but hard data to support this policy are lacking, Dr. Alexander Turchin of Brigham and Women's Hospital in Boston and colleagues note.

In patients being treated for high blood pressure (hypertension), stepping up treatment when blood pressure is elevated is an important indicator of quality of care. The researchers therefore conducted a review of electronic medical records to assess blood pressure management by 301 internists affiliated with Brigham and Women's Hospital and Massachusetts General Hospital in Boston.

Their study included 8,127 hypertensive patients with diabetes who had a high blood pressure reading documented in their records at least once between 2000 and 2005. The team analyzed the temporal relationship between board certification and treatment intensification, defined as an increase in dose, a change from one drug to another or the addition of a new drug.

They identified 54,000 visits in which patients' blood pressure was high; treatment was adjusted in 20 percent of these encounters. Forty-three percent of visits were with physicians who were last certified more than 10 years previously.

The frequency of treatment intensification was highest (27 percent) for 103 internists who had passed their boards during the year prior to the visit, the investigators found, and lowest (7 percent) for the 6 physicians who were last certified 31 years ago.

Further analysis revealed that every decade since physicians' last board certification was associated with a 21 percent drop in the likelihood of their modifying therapy in response to an elevated blood pressure reading.

These findings support the current policies of mandatory re-certification, Turchin and colleagues maintain. Furthermore, they say, "the study provides indirect evidence that more intensive educational efforts could help improve quality of care delivered by physicians."

"To ensure continuing improvement in the standards of healthcare, we should aim for nothing less," Turchin and his associates conclude.

SOURCE: Circulation, online January 21, 2008.