General Practitioners' coronary risk estimates, decisions to start lipid-lowering treatment, gender and length of clinical experience: their interactions in primary prevention.
OBJECTIVE
We investigated whether the risk estimates of General Practitioners (GPs) and their treatment decisions mutually influence each other and whether factors not related to the patient's risk, such as the gender and length in clinical practice, interact.


BACKGROUND
The quantitative assessment of the absolute risk of developing coronary heart disease (CHD) and the decision to start treatment with lipid-lowering drugs are crucial tasks in the primary prevention of CHD.


METHODS
Nine clinical vignettes, four rated high-risk and five rated low-risk according to the Framingham equation, were mailed to three groups of 90 randomly selected GPs in Stockholm. One group (R) was asked to estimate the risk of CHD within 10 years on a visual analogue scale. A second group (R1D) was asked to estimate the risk and to specify whether they would recommend a pharmacological lipid-lowering treatment. A third group (D) only to indicate whether they would recommend treatment.


RESULTS
Response rate ranged from 42.2% to 45.6%. The median risk estimates were higher in the R group than in the R1D group (difference not statistically significant). R1D group showed higher proportions of correct decisions to start treatment compared with the R group (86.2% versus 77.5%, P50.19). More correct decisions were made by female doctors (OR 1.77, 95% CI 1.19-2.61, P50.004) and by less experienced doctors (OR 0.97, 95% CI 0.95-0.99, P50.016).


CONCLUSIONS
The task of making CHD risk estimates and the task of making decisions whether to start lipid-lowering treatment do not seem to influence each other. The gender of physicians and the length of clinical experience seem to affect treatment decisions. Female GPs and less experienced GPs are more likely to make correct decisions. However, the relatively low response rate to the questionnaires may limit the generalizability of these results.
Internal Medicine, Ospedale S Elia, Caltanissetta, Sicily, Italy. federico.vancheri@ki.se
Federico
F
Vancheri
Lars-Erik
LE
Strender
Lars G
LG
Backlund
D000328:Adult; D000367:Age Factors; D000368:Aged; D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D058005:General Practitioners / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000379:methods / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013548:Sweden
D000960:Hypolipidemic Agents