title: Factors influencing doctors' selection of dabigatran in non-valvular atrial fibrillation.
abstract: OBJECTIVE
  This study was designed to examine the factors that influence doctors' decision in initiating or switching from warfarin to dabigratran.
  
  
  METHODS
  A survey questionnaire was sent to 181 doctors who were most likely to prescribe dabigatran (e.g. cardiologists and general internists) at the University of California, San Francisco Medical Center between November 2011 and February 2012. Survey participants were asked to complete an electronic or a paper version of the questionnaire, which consisted of 17 multiple-choice questions. Fisher's exact test and Cochran-Mantel-Haenszel test were used to compare survey responses between cardiologists and general internists.
  
  
  RESULTS
  A total of 65 survey responses were received (35.9% response rate). There were 13 cardiologists and 51 general internists who participated in the study. Cost (25%), renal function (21%) and CHADS2 score (18%) were the three factors doctors considered most often to determine a patient's eligibility for dabigatran in warfarin-naïve patients. On the other hand, histories of unstable international normalized ratio (37%) and missed appointments (17%) along with cost (19%) were most often considered in patients on warfarin. Cardiologists had prescribed dabigatran more often and had a significantly higher level of comfort with prescribing the drug than general internists (P = 0.003; 77% vs. 27%).
  
  
  CONCLUSIONS
  Cost was the most important factor influencing doctors' decision to prescribe dabigatran. Safety and effectiveness of dabigatran as well as patient preference were additional factors influencing their decision. General internists were less comfortable with prescribing dabigatran than cardiologists.
authors: Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
authors: Cindy
authors: C
authors: Huang
authors: Michele
authors: M
authors: Siu
authors: Lily
authors: L
authors: Vu
authors: Soo
authors: S
authors: Wong
authors: Jaekyu
authors: J
authors: Shin
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D000069604:Dabigatran; D004608:Eligibility Determination / Q000379:methods / Q000706:statistics & numerical data; D005252:Fees, Pharmaceutical; D005260:Female; D019538:Health Care Surveys; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran