Factors influencing GPs' decisions on the treatment of hypercholesterolaemic patients.
OBJECTIVE
To study factors influencing GPs' decisions to prescribe lipid-lowering drugs and how their judgements agree with the Swedish guidelines on hyperlipidaemia.


METHODS
Postal questionnaire.


METHODS
Primary health care. Authentic written case descriptions of patients, all with a cholesterol value of at least 5.5 mmol/l and with variations in seven other variables (cues) in a Clinical Judgement Analysis (CJA) design.


METHODS
Sixty randomly selected primary health care doctors in the south-eastern Stockholm area.


RESULTS
Thirty-eight doctors answered the questionnaire. Coronary heart disease had the highest influence on judgements, followed by cholesterol. The majority of doctors used two or three of the eight cues. Doctors differed markedly in their strategies. One in four did not use coronary heart disease in their judgements, even though all patients with this risk factor present (12/40) should receive pharmacological treatment, according to the guidelines. Doctors who adhered to the guidelines in this respect were younger than those who did not. The GPs' insights into their own strategies were good.


CONCLUSIONS
The results indicate that doctors use very different judgement strategies for drug prescription concerning patients with hypercholesterolaemia. A fairly large subgroup of the doctors did not include coronary heart disease in their judgements, in contrast to the present guidelines.
Backlund
L
L
Gustavsberg Health Centre, Department of Clinical Sciences, Karolinska Institutet, Family Medicine, Stockholm, Huddinge, Sweden.
Danielsson
B
B
Bring
J
J
Strender
L E
LE
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D003463:Cues; D003657:Decision Making; D011307:Drug Prescriptions; D004363:Drug Utilization; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007600:Judgment; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010821:Physicians, Family / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden
D000924:Anticholesteremic Agents