The objective is to identify practice patterns and attitudes of and barriers faced by US physicians assessing thromboembolism/stroke risk and managing anticoagulation in atrial fibrillation (AF) to determine educational needs. Case-based surveys were used to assess practice patterns, guideline use, barriers, and attitudes; 51 cardiologists and 50 primary care physicians (PCPs) were surveyed. Most cardiologists use validated risk scoring systems to assess thromboembolism/stroke risk, and more than half of PCPs use clinical experience. Assessment of bleeding risk varied; more than half of respondents rely on clinical judgment or patient bleeding history. The most commonly used prophylactic agents are warfarin/another vitamin K antagonist (PCPs) or antiplatelet agents (cardiologists). Newer anticoagulants are used less frequently. Bleeding risk, need for frequent monitoring (vitamin K antagonists), and medication costs were the most significant barriers. Cardiologists and PCPs could benefit from education on validated scoring systems to assess risk of thromboembolism/stroke and bleeding in AF, on newly released AF guidelines, and on newer anticoagulants.
BackgroundThe purpose of this study was to identify differences in perceptions of care regarding postherpetic neuralgia, including communication patterns between patients and physicians and levels of satisfaction with therapies and care.MethodsA survey was developed for physicians (neurologists, internists, and family physicians) and patients with postherpetic neuralgia in order to determine their perspectives on its management.ResultsA total of 142 eligible patient respondents were included in the study, and responses were compared with those of 150 primary care physicians and 76 neurologist respondents. Few patients and physicians indicated satisfaction with the currently available treatments for postherpetic neuralgia. While nearly all physicians responded that they discuss the cause of postherpetic neuralgia with a patient, one in four patients indicated that their physician did not discuss the cause. Similarly, one in four patients were not aware of the duration of postherpetic neuralgia, the treatment side effects, or what to expect from treatment. Patients may be less likely to discuss treatment side effects and quality of life issues than physicians perceive.ConclusionPhysicians and patients have similar perceptions regarding treatment options for postherpetic neuralgia; however, certain gaps in communication were evident, which may be attributable to physician knowledge and communication skills with patients. Strategies to improve issues of expected outcomes and side effects of treatment may be useful to physicians.
Introduction: Detecting congestion and determining risk for hospitalization represents a clinical challenge in heart failure (HF). New technology allows clinicians to monitor pulmonary artery pressure (PAP) chronically and to tailor therapy in HF patients based on PAP changes. This study’s objective was to assess the relationship between cardiologists’ knowledge and attitudes with case-based decision making in HF. Hypothesis: A positive relationship will exist between knowledge and case-based application of PAP in HF management. Methods: A 31-question, online, continuing medical education (CME) survey was developed, including knowledge (pathophysiology of HF/PAP, clinical trials) and case-based questions. Chi-square analysis was used to compare the effects between attitudes of respondents among knowledge and case-based questions. Logistic regression was employed to determine impact of knowledge and attitudes on treatment practices in HF. Results: 485 cardiologists completed the survey with average cumulative correct scores of 54% for case-based questions. Cardiologists had poor knowledge of the pathophysiology of HF, PAP, and the clinical trials related to this topic, with only 6% answering 80% or more questions correctly. There was strong association between higher knowledge and case competency. Cardiologists who understood the importance of fluid retention were more knowledgeable ( P <0.0001; d =0.69) and performed better on case questions ( P <0.0001; d =0.46) than those that did not. Cardiologists comfortable managing and titrating HF medications were more knowledgeable ( P <0.0001; d =0.82) and performed better on case questions (P= 0.003; d =0.51) than those that were not. Linear regression analysis suggested increase in HF/PAP pathophysiology knowledge by 1 question would result in an 18% improvement in performance (P< 0.0008), indicating that knowledge of HF/PAP pathophysiology is a strong predictor of physician performance. Conclusions: A significant positive relationship between cardiologists’ knowledge/attitudes and their case-based application of PAP in management of HF supports the need to develop CME activities that align physicians’ knowledge and performance to improve outcomes and reduce hospitalizations.
Background: TRA is associated with reduced vascular complications and costs; however, studies show low adoption of TRA in the United States (US) relative to other countries. The underlying reasons for this are unclear. Methods: Applying the framework of the Theory of Planned Behavior (TPB), a psychological construct that links attitudes, perceptions, & behavior, we developed a survey to identify factors associated with TRA use. TPB has 3 domains: attitudes (beliefs about TRA outcomes), normative beliefs (perceptions of how other physicians judge TRA use), and control beliefs (awareness of factors that facilitate or impede TRA use). A survey that included questions specific to each domain was developed, tested for construct & content validity, & administered to 201 US interventional cardiologists with varying self-reported rates of TRA use. Multivariable logistic regression was used to determine factors associated with TRA use; the model included domains of TPB and characteristics of the respondents. Results: The mean time since completion of interventional training for the study sample was 14.4 ± 10.2 yrs. The mean number of patients/week was 69, with 32% requiring catheterization, & 25% requiring PCI. Factors associated with TRA use included physician attitudes toward TRA, practice environment (e.g. support from the hospital or colleagues) and to a lesser extent, patient volume and number of operators using the catheterization laboratory (Table). Conclusions: Using principles from TPB, we identified factors associated with TRA use. These data are useful in refining TRA educational initiatives and suggest that broadening the scope beyond individual providers may increase TRA adoption. In addition, this methodology may provide a future model for initiating the adoption of other novel techniques into interventional cardiology practice. Table. Significant predictors of TRA use
19 Background: A significant thrust within recent innovation has been focused on improving the quality of diagnostics and system adherence to guidelines; equally important are attempts to improve patient-specific therapy plans, or personalized medicine. These two approaches—quality improvement and personalized medicine—have equally laudable goals toward improving cancer care and outcomes, yet have not been fully examined for their concomitant impacts, particularly among and within interprofessional teams, in which a mix of health care providers present varied foci within the oncology care delivery process. Methods: Twenty phone-based qualitative interviews were facilitated with community-based medical oncologists in active practice in July 2012. Transcripts of the interview sessions were examined through grounded qualitative analysis, and overall findings are presented. Results: Oncologists hold varied definitions of personalized medicine, yet share understanding of the central nature of the patient within personalized medicine care delivery. More varied are oncologists’ perceptions of the goals and value of implementation of quality improvement initiatives, which range from those focused on pragmatic concerns of the oncology clinic, such as patient flow, to the quality of clinical decision-making and outcomes. Oncologists value well-functioning and clearly defined roles within interprofessional teams within oncology practices, both among other clinicians and allied team members. However, functional and perceptional gaps remain in the practical application of quality improvement objectives within interprofessional teams and within the implementation of personalized oncology care delivery. Conclusions: This exploratory qualitative analysis approach provides grounded identification of practicing oncologists’ definitions of quality improvement, personalized medicine, interprofessional care delivery, and the practical interrelationships between these domains, enabling a framework for future research and quality initiatives.
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