Do Physicians' Beliefs About Coronary Risk Factors Account for Poor Screening and Treatment Rates?

Abstract

The authors hypothesized that the widely observed low rates of coronary risk factor screening and treatment among cardiologists could be due to lack of belief in the importance of risk factors. They performed an audit of 160 randomly selected medical records of patients with coronary artery disease and surveyed the attending physicians' ranking of importance of individual risk factors to determine the extent of risk factor screening and treatment done by these physicians. Screening and treatment rates for individual risk factors were highly variable but generally well below expected. There was no correlation among rank orders of screening rates, treatment rates, and physician-rated importance of each risk factor. These results suggest that lack of belief in risk factor importance does not explain failure of physicians to screen for and treat risk factors in coronary patients.

Factors Associated With Implementation of Preventive Care Measures in Patients With Diabetes Mellitus

“…To our surprise, physicians who disagreed with the outcomes had a higher rate of determining HDL-C in their patients, unrelated to the differences in patients' characteristics. In another study 70 the physician's rating of the importance of a risk factor had no correlation with his or her screening and treatment rate of this factor. To the extent that physicians accurately recall their compliance with guidelines, perhaps, disagreement with the outcomes identified physicians who were more knowledgeable and more critical about the guidelines and who were less likely to ignore them.…”

“…This supports studies reporting a poor correlation between a physician's stated belief and performance. [70][71][72][73] In this study, physicians having lower performance rates seem to be aware of it. This has implications for medical education or for initiatives to assist individual physicians in achieving better compliance.…”

From Death and Disability to Patient Empowerment: An Interprofessional Partnership to Achieve Cardiovascular Health in Canada

“…Physicians have been found to have difficulty meeting the standards recommended in major clinical practice guidelines even where they strongly believe that preventive care is important and that risk factors for cardiovascular disease can and should be reduced. For example, only about half of physicians routinely advise people who smoke to quit, [3][4][5] and only a third of patients needing treatment for high blood cholesterol in the United States are receiving it. [6][7][8] These examples illustrate that the gap between recommended and actual practice around cardiovascular disease in primary care settings extends beyond Canadian borders.…”