       Document 0177
 DOCN  M9590177
 TI    General practitioners' tacit and stated policies in the prescription of
       lipid lowering agents.
 DT    9509
 AU    Evans JS; Harries C; Dennis I; Dean J; Department of Psychology,
       University of Plymouth.
 SO    Br J Gen Pract. 1995 Jan;45(390):15-8. Unique Identifier : AIDSLINE
       MED/95298410
 AB    BACKGROUND. Research into general practitioners' prescribing behaviour
       with regard to lipid lowering agents has relied on survey methods which
       presume that doctors have insight into their prescribing behaviour and
       can describe it accurately. AIM. This study set out to measure the tacit
       policies used by general practitioners in prescribing lipid lowering
       agents and to compare these with their stated policies. METHOD. Effects
       of 13 separate cues on decisions to prescribe were examined. The cues
       included cholesterol levels and a number of associated risk factors for
       coronary heart disease. Doctors rated 130 imaginary cases presented by a
       computer. Thirty five general practitioners in the Plymouth area
       participated in the study. Their ages ranged from 31 to 55 years and all
       but four were men. The raw data in each case was a rating of the
       likelihood that the doctor would prescribe for the patient described.
       These were converted into statistical weightings by use of multiple
       linear regression. The pattern of (standardized) weights constituted the
       tacit policy for each doctor. Stated policies were measured in a
       subsequent interview by asking doctors to rate the influence of each
       cue. RESULTS. Both tacit and stated policies diverged widely between
       different doctors. Most doctors overestimated the number of cues that
       had actually influenced their decisions, and many believed that they had
       taken into account associated factors for coronary heart disease when
       they had not. On lifestyle related risks doctors were generally less
       likely to treat overweight people and most stated this as their policy.
       Most were also less likely to treat smokers but some had the opposite
       policy. Those less likely to treat smokers were also less likely to
       treat obese patients. There was also considerable variation in the
       extent to which the doctors took account of the attitude of the patient
       to receiving treatment. CONCLUSION. Doctors' policies are highly
       variable and particularly inconsistent in the treatment of smokers.
       Relevant risk factors may be ignored--even though they are
       understood--because the risk assessment involved is too psychologically
       complex a task to be performed intuitively. Decision aids and clear
       protocols are needed in this area.
 DE    Adult  Antilipemic Agents/*ADMINISTRATION & DOSAGE  Coronary
       Disease/ETIOLOGY  *Decision Making  England  *Family Practice  Female
       Human  Hyperlipidemia/*DRUG THERAPY  Male  Middle Age  *Physician's
       Practice Patterns  Prescriptions, Drug  Risk Factors  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

