title: Nonmedical influences on the use of cholinesterase inhibitors in dementia care.
abstract: We examined primary care physicians' (PCPs) attitudes toward cholinesterase inhibitors (ChEI) to better understand nonmedical factors influencing prescribing decisions in dementia care. In a cross-sectional, qualitative study, 40 PCPs were interviewed concerning their general approach to managing patients with dementia, and their care for a particular dementia case. Three readers independently identified and categorized themes associated with prescribing ChEI. Physicians' attitudes toward ChEI were also coded. Physicians were predominantly ambivalent (51%) or negative (31%) about prescribing ChEI for their patients with dementia. Nonmedical factors affecting prescribing included lack of knowledge, dependence on specialists, influence of family wishes and involvement, and physicians' values. PCPs reported that lack of knowledge and experience made prescribing decisions for ChEI challenging. Physicians reported feeling pressured by families to prescribe ChEI. Under these ambiguous conditions, some physicians prescribed medications simply to be able to offer "something" to patients.
authors.affiliation: University of California, San Diego, La Jolla, CA 92093, USA. cfranz@ucsd.edu
authors.forename: Carol E
authors.initials: CE
authors.lastname: Franz
authors.forename: Judith C
authors.initials: JC
authors.lastname: Barker
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.forename: Yvette
authors.initials: Y
authors.lastname: Flores
authors.forename: Sheila
authors.initials: S
authors.lastname: Krishnan
authors.forename: Ladson
authors.initials: L
authors.lastname: Hinton
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003657:Decision Making; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome