QJM vol. 98 no. 1 © Association of Physicians 2005; all rights reserved.
Physicians' attitudes to the pharmacological treatment of patients with stable angina pectoris
From the 1Centre de recherche du Centre hospitalier de l'Université de Montréal, 2Divisions of Cardiology and Clinical Epidemiology, McGill University Health Centre, 3Collège des médecins du Québec, 4Département d'administration de la santé, Université de Montréal, and 5Agence d’évaluation des technologies et des modes d'intervention en santé and McGill University, Montreal, Quebec, Canada
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 ß-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 ß-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.
Address correspondence to Professor M.-D. Beaulieu, Centre de recherche du CHUM, Hôpital Notre-Dame, Pavillon L.-C. Simard, 8e étage1560, rue Sherbrooke Est., Montréal (Québec), Canada H2L 4M1. e-mail: maried.beaulieu{at}sympatico.ca