GPs' decisions on drug treatment for patients with high cholesterol values: A think-aloud study

Bäcklund, L; Skånér, Ylva; Montgomery, Henry; Bring, Johan; Strender, Lars-Erik

doi:10.1186/1472-6947-4-23

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…Our finding of lower pre-treatment blood pressures in younger patients concurs with that of a survey in New Zealand [25]. It is also consistent with findings relating to cardiovascular prevention through cholesterol lowering: when describing their decision making GPs more commonly mention individual risk factor values than numerical risk estimates [26]. Decision making based on a single risk factor is more compromised by chance variation in that risk factor.…”

Section: Discussionsupporting

confidence: 88%

The Effect of Chance Variability in Blood Pressure Readings on the Decision Making of General Practitioners: An Internet-Based Case Vignette Study

2012

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BackgroundGuidelines for the management of blood pressure (BP) in primary care generally suggest that decisions be made on the basis of specific threshold values (e.g. BP 140/90 mmHg); but this fails to adequately accommodate a common cause of variation – the play of chance.ObjectiveTo determine the impact of chance variability in BP readings on the clinical decision making of general practitioners (GPs) regarding anti-hypertensive treatment and cardiovascular risk management.MethodWe used an internet based study design, where 109 GPs were assigned to manage one of eight case vignettes (guidelines would recommend treatment for only one of the eight) and presented with blood pressure readings that were randomly selected from an underlying population.ResultsSeventeen (15.6%, 17/109) GPs consulted the vignette for whom treatment was recommended, but only 7/17 (41.2%) GPs prescribed treatment, whereas 14/92 (15.2%) GPs prescribed medication to the other vignettes. When deciding to follow-up a vignette GPs were influenced by threshold values for systolic and diastolic BP, but not by the overall cardiovascular risk. If the first reading was a low BP (systolic <140, diastolic <90) GPs were highly likely to discharge the vignette and follow-up a high BP reading (diastolic >90 or systolic BP≥140). Similar factors predicted the decision to prescribe a drug, although the vignette’s cardiovascular risk (>20%) was now statistically significant (p = 0.03).ConclusionsGP decision making, whilst generally consistent with guidelines, appears to be compromised by chance variation leading to under and over treatment. Interventions to adequately accommodate chance variability into clinical decision making are required.

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Section: Discussionsupporting

confidence: 88%

The Effect of Chance Variability in Blood Pressure Readings on the Decision Making of General Practitioners: An Internet-Based Case Vignette Study

2012

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“…It appears that GPs and specialized practitioners do not share EBM's paramount concern with clinical effectiveness, but instead see it as one consideration in a wider concept that also includes patient-oriented concerns such as patient satisfaction, minimal infliction on patients' day-to-day life and incompatibility with other needs or treatments. Similar findings have been reported in the literature and seem to indicate a general consensus amongst the medical community regarding the limited value of EBM in promoting effective health care (Tomlin et al 1999;Backlund et al 2004;Skoglund et al 2007).…”

Section: Discussionsupporting

confidence: 83%

Patient-based medicine: aligning patients’ perspectives on disease and treatment with evidence-based medicine criteria

Rohrbacher¹,

Marx

Schaufler

et al. 2008

J Public Health

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“…These aspects of the coding are described in previous papers [8,9] and are not used in the present article.…”

Section: Methodsmentioning

confidence: 99%

“…In two previous papers that were based on the same think-aloud experiment, we investigated the validity of Think-Aloud Reports compared with rating data for reflecting the decision process over time [8], and we analysed the importance of different patient characteristics and risk factors regarding prescription decisions [9]. …”

Section: Introductionmentioning

confidence: 99%

The role of guidelines and the patient's life-style in GPs' management of hypercholesterolaemia

Bäcklund¹,

Skånér²,

Montgomery³

et al. 2004

BMC Fam Pract

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Background: Recent Swedish and joint European guidelines on hyperlipidaemia stress the high coronary risk for patients with already established arterio-sclerotic disease (secondary prevention) or diabetes. For the remaining group, calculation of the ten-year risk for coronary events using the Framingham equation is suggested. There is evidence that use of and adherence to guidelines is incomplete and that tools for risk estimations are seldom used. Intuitive risk estimates are difficult and systematically biased. The purpose of the study was to examine how GPs use knowledge of guidelines in their decisions to recommend or not recommend a cholesterol-lowering drug and the reasons for their decisions.

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GPs' decisions on drug treatment for patients with high cholesterol values: A think-aloud study

Abstract: Background: The purpose was to examine how General Practitioners (GPs) use clinical information and rules from guidelines in their decisions on drug treatment for high cholesterol values.

Cited by 10 publications

References 13 publications

The Effect of Chance Variability in Blood Pressure Readings on the Decision Making of General Practitioners: An Internet-Based Case Vignette Study

The Effect of Chance Variability in Blood Pressure Readings on the Decision Making of General Practitioners: An Internet-Based Case Vignette Study

Patient-based medicine: aligning patients’ perspectives on disease and treatment with evidence-based medicine criteria

The role of guidelines and the patient's life-style in GPs' management of hypercholesterolaemia

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