Why physicians favor use of percutaneous coronary intervention to medical therapy: a focus group study.
BACKGROUND
Percutaneous coronary intervention (PCI) is performed in many patients with stable coronary artery disease, despite evidence of little clinical benefit over optimal medical therapy.


OBJECTIVE
To examine physicians' beliefs, practices, and decision-making regarding elective PCI.


METHODS
Six focus groups, three with primary care physicians and three with cardiologists. Participants discussed PCI using hypothetical case scenarios. Transcripts were analyzed using grounded theory, and commonly expressed themes regarding the decision-making pathway to PCI were identified.


METHODS
Twenty-eight primary care physicians and 20 interventional and non-interventional cardiologists in Butte County, Orange County, and San Francisco Bay Area, California, in 2006.


RESULTS
A number of factors led primary care physicians to evaluate non-symptomatic or minimally symptomatic patients for coronary artery disease and refer them to a cardiologist. The use of screening tests often led to additional testing and referral, as well as fear of missing a coronary stenosis, perceived patient expectations, and medicolegal concerns. The end result was a cascade such that any positive test would generally lead to the catheterization lab, where an "oculostenotic reflex" made PCI a virtual certainty.


CONCLUSIONS
The widespread use of PCI in patients with stable coronary artery disease--despite evidence of little benefit in outcomes over medical therapy--may in part be due to psychological and emotional factors leading to a cascade effect wherein testing leads inevitably to PCI. Determining how to help physicians better incorporate evidence-based medicine into decision-making has important implications for patient outcomes and the optimal use of new technologies.
Lin
Grace A
GA
Division of General Internal Medicine, University of California, San Francisco 94143, USA.
Dudley
R Adams
RA
Redberg
Rita F
RF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D002309:Cardiology; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D015607:Stents / Q000706:statistics & numerical data