Physicians' attitudes to the pharmacological treatment of patients with stable angina pectoris

• Published in: QJM : An International Journal of Medicine 2005-01, Vol.98 (1), p.41-51
• Main Authors: Beaulieu, M.-D., Brophy, J., Jacques, A., Blais, R., Battista, R.N., Lebeau, R.
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Angina Pectoris - drug therapy; Attitude of Health Personnel; Biological and medical sciences; Cardiology. Vascular system; Clinical Competence; Coronary heart disease; Female; General aspects; Guideline Adherence; Heart; Humans; Hypolipidemic Agents - therapeutic use; Linear Models; Male; Medical sciences; Middle Aged; Physicians - psychology; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic; Quebec; Surveys and Questionnaires
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hci006

Background: Little is known about how physicians’ knowledge of and attitudes to practice guidelines for stable angina may influence their implementation. Aim: To explore the association between physicians’ demographics, their knowledge, and opinions about stable angina and their self-reported adherence to guideline recommendations. Design: Questionnaire-based survey. Methods: We surveyed 1228 Quebec physicians using a questionnaire based on the ‘awareness-to-adherence’ conceptual framework to measure their adherence with recommendations for the pharmacological treatment of stable angina. Independent predictors of adherence with the targeted recommendations were determined by stepwise linear regression analysis. Results: We received 877 (71.4%) responses from the 1228 eligible physicians. More than 90% of respondents were aware of and agreed with the targeted recommendations. However, the adoption rate varied, even among physicians who generally agreed with the guidelines. Factor analysis indicated that most physicians agreed with recommendations concerning ASA. More negative attitudes were expressed toward β-blockers and hypolipaemic drugs. Respondents trusted the recommendations of a variety of scientific and professional organizations. Awareness, agreement, and adoption were the strongest predictors of adherence for the three recommendations. Physician demographics and practice characteristics did not predict adherence. Discussion: Physicians were aware of and agreed with the recommendations, so additional large-scale dissemination of the guidelines would be unlikely to improve prescription patterns. However, negative attitudes about β-blockers and hypolipaemic therapy affected adherence to recommendations for these drugs. Continuing medical education interventions involving local opinion leaders might address some of the obstacles identified.