Prescribing of beta-blockers after myocardial infarction: a preliminary study of physician motivations and barriers.
BACKGROUND
Clinical practice guidelines (CPGs) recommend beta-blocker medications in the management of post-myocardial infarction (MI) patients to prevent subsequent MI; evidence suggests that this therapy continues to be underutilized. The decision-making process that physicians use for treating post-MI patients should be explored; behavior-change interventions have been proposed among researchers in this field.


OBJECTIVE
The aim of this pilot study was to develop measures for examining this issue using the transtheoretical model (TTM) of change, including physician stage of readiness for change and physician salience (ie, decisional balance) for the pros (ie, facilitators) and cons (ie, barriers) of prescribing beta-blockers to post-MI patients.


METHODS
In this cross-sectional study, a TTM-based questionnaire was developed from the literature and from interviews with a convenience sample of physicians practicing in cardiology; the questionnaire was subjected to expert panels for revision and was pretested. It was then mailed to all physicians practicing family medicine, internal medicine, or cardiology during the autumn of 2003 in northern West Virginia, a state with a high prevalence of cardiovascular disease and MI-related mortality.


RESULTS
Among the 309 physicians who received the questionnaire, 103 responded; 55 responses were complete and eligible for inclusion in the analysis. Most (92.7%) responded to the TTM measures in the action and maintenance stages of change for prescribing beta-blockers for post-MI patients. Results also suggested they had significant salience (P < 0.05) for the cons of prescribing beta-blocker therapy to patients with relative contraindications that were indicated in the earlier versions of the CPGs, but not in the latest version. Other specific barriers to prescribing were also identified.


CONCLUSIONS
Results of this preliminary study suggest that it would be relevant to increase physician knowledge of the updated CPGs regarding use of beta-blockers in the presence of conditions previously deemed relative contraindications.
Kavookjian
Jan
J
Department of Pharmacy Care Systems, Auburn University Harrison School of Pharmacy, Auburn University, Alabama 36849-5506, USA. kavooja@auburn.edu
Mamidi
Sekhar
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000517:prevention & control; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014903:West Virginia
D000319:Adrenergic beta-Antagonists