title: The impact of physician attitudes and beliefs on treatment decisions: lipid therapy in high-risk patients.
abstract: BACKGROUND
  Despite clinical guidelines, many patients with hypercholesterolemia do not achieve treatment goals in clinical practice.
  
  
  OBJECTIVE
  This study examined physician attitudes and beliefs about hyperlipidemia and whether they are associated with lipid treatment decisions.
  
  
  METHODS
  This was a cross-sectional study of 107 physicians who completed a validated survey of attitudes and beliefs about hyperlipidemia and provided treatment histories for 1187 statin-treated patients with coronary heart disease (CHD) or who were CHD risk-equivalent. Logistic regressions (using generalized estimating equation) estimated the impact of patient characteristics and physician attitudes and beliefs on whether a patient received increases in the statin dose.
  
  
  RESULTS
  Approximately 70% of the 843 patients who were not at low-density lipoprotein cholesterol goal (<100 mg/dL) with initial statin therapy received a dose increase, although only one-half attained goal. Controlling for patient characteristics, patients whose physicians believed "close enough to goal is good enough" had 47% lower odds of having a dose increase (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.34-0.82), whereas patients whose physicians believed "statins are effective" had almost twice the odds of having a dose increase (OR, 1.78; 95% CI, 1.05-3.00).
  
  
  CONCLUSIONS
  Although the understanding of basic and clinical science remains fundamental, clinical guideline authors may want to consider the importance of physician attitudes and beliefs in determining translation of their guidelines into clinical practice.
authors.affiliation: Outcomes Research and Econometrics, Medstat, Inc., New Hope, Pennsylvania, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Foley
authors.forename: Margo A
authors.initials: MA
authors.lastname: Denke
authors.forename: Sachin
authors.initials: S
authors.lastname: Kamal-Bahl
authors.forename: Ross
authors.initials: R
authors.lastname: Simpson
authors.forename: Kathy
authors.initials: K
authors.lastname: Berra
authors.forename: Shiva
authors.initials: S
authors.lastname: Sajjan
authors.forename: Charles M
authors.initials: CM
authors.lastname: Alexander
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003430:Cross-Sectional Studies; D003657:Decision Making; D004305:Dose-Response Relationship, Drug; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014481:United States
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors