Preferences Of Doctors Research Articles

MA10.11 Patient-Reported Doctor Communication and Preference on Treatment Decision Making: Oligometastatic vs Metastatic Lung Cancer

MA10.11 Patient-Reported Doctor Communication and Preference on Treatment Decision Making: Oligometastatic vs Metastatic Lung Cancer

The choice of optimal therapy for ER+ HER2-metastatic breast cancer (PROMETHEUS): all-Russian analysis of physicians’ preferences – updated survey results

Cyclin-dependent kinase 4/6 inhibitors (iCDK4/6) are the generally accepted standard of care for the treatment of luminal HER2-negative metastatic breast cancer (ER+HER2- mBC). Data from randomized and observational studies have proven the high effectiveness of the combination of iCDK4/6 and endocrine therapy (ET) both in the 1st and in subsequent lines. The use of new drugs in real clinical practice is determined by a number of factors, including the awareness of doctors, their personal experience and subjective preferences, as well as financial support and availability in a particular region. To assess the frequency of prescription of CDK4/6, as well as other types of treatment in the 1st‑2nd line of therapy for ER+ HER2- mBC in real clinical practice in Russia, as well as to determine the factors and preferences of doctors influencing their choice, the National Association of Oncomammologists (NAOM) conducted a survey “Prometheus” of oncology specialists. From February 15 to August 30, 2023, a web survey of healthcare professionals who treat patients with mBC was conducted on the website anketolog.ru. An invitation to survey was sent out through the NAOM database, 112 questionnaires were received and processed. Earlier, in 2020, the “Prometheus” survey was conducted on the territory of the Russian Federation for a similar purpose. In this paper, we present the results of an updated and expanded survey and evaluate changes that have occurred over the past 3 years in actual clinical practice. The results of a 2023 survey conducted in the Russian Federation on the choice of early-line therapy for ER+HER2- mBC showed that, compared with the 2020 survey, the level of “trust” in iCDK4/6 has increased among practicing physicians, and the indications for their use have expanded, including visceral metastases (and even pending visceral crisis), the indications for prescribing chemotherapy in the 1st line have narrowed. When using monoET in the 1st line, the majority of respondents prescribe iCDK4/6 in the 2nd line. Obviously, the wider use of iCDK4/6 is associated not only with the accumulation of clinical knowledge and experience in the use of drugs, but also with improved drug supply. However, the main limitations to the use of iCDK4/6 are still insufficient funding and organizational difficulties. However, it should be noted that 1/5 of the respondents do not face any restrictions and widely prescribe combination therapy.

Factors Predicting the Choice of Specialization Among Medical Students and Junior Doctors in Oman: A Cross-Sectional Study

Background: Choosing a medical specialization is a crucial, career-defining decision for medical students and junior doctors. Objectives: This study aimed to identify variables impacting junior postgraduate doctors' and medical students' choice of specialty in Oman. Methods: A cross-sectional study was conducted at Sultan Qaboos University (SQU) and the Oman Medical Specialty Board (OMSB) in Muscat, Oman. A two-part, self-administered questionnaire was electronically distributed to 247 respondents of different positions and levels of education, including doctors enrolled in the General Foundation Program, interns, and medical students undergoing their junior and senior clinical rotations. Sociodemographic characteristics were compared to determine factors influencing the choice of medical specialization. Results: The most popular choice of specialty was pediatrics (14.6%), followed by family medicine (10.9%), psychiatry (9.3%), and general medicine (8.5%). Medical specialties were chosen more frequently than surgical or diagnostic specialties (60.7% vs. 27.5% and 10.9%, respectively), regardless of gender or current position/level. Significant variations in specialty preferences were observed based on the respondents’ level of paternal educational attainment (P = 0.026) and future desired location of residency (P < 0.001). The factors identified by the participants as most important when selecting preferred specialties were working hours/lifestyle after completion of training (77.3%), positive experiences with a clinician/teacher of a particular specialty (72.5%), and income potential (70.9%). Conclusions: The findings of this study may contribute to healthcare workforce planning strategies aimed at supporting insufficiently staffed specialties, taking into account the needs of patients as well as the interests and preferences of future doctors.

Политика реализации национальных проектов России в рамках здравоохранения

This article highlights the government policy of the Russian Federation within the framework of implementing the National Healthcare Project aimed at improving the health of the working-age population, increasing the average life expectancy of Russians to 80 years, reducing infant mortality, combating cardiovascular diseases, and the spread of malignant neoplasms. It is established that the Russian state actively participates in creating prerequisites for further modernization of the healthcare sector through the current implementation of the National Healthcare Project. However, additional and coordinated efforts of various subjects of the Russian Federation and regions in the implementation of the Healthcare Project are needed to achieve more effective results and fulfill the set tasks in time. Despite progress in healthcare reform, significant challenges persist. These include inadequate funding, especially in the public sector, which results in low salaries for healthcare professionals and limited access to essential medical equipment and facilities. Additionally, there is a shortage of skilled personnel, exacerbated by the preference of young doctors for private practice over public service. The aging population further strains healthcare resources, necessitating specialized care for elderly citizens. In conclusion, the successful implementation of National Healthcare Projects in Russia requires concerted efforts from government agencies, healthcare providers, and other stakeholders. Addressing funding shortages, improving workforce retention, and meeting the needs of an aging population are essential steps towards achieving the goals outlined in the National Healthcare Project.

Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment.

Retaining doctors and dentists in remote areas of Indonesia remains a national priority of the Indonesian government. The purpose of this study was to analyze the interventions for retention of doctors and dentists in remote areas using the discrete choice experiment (DCE) approach. A DCE was conducted to investigate preferences of doctors and dentists for retention in remote areas. This research was conducted in 78 primary healthcare settings across 15 provinces in Indonesia. The conditional logit model was used to explore stated preferences for each attribute. The total number of respondents was 158, including 113 doctors and 45 dentists. In general, doctors placed the highest preference on getting priority for government scholarships to facilitate retention in remote areas (OR=5.65, p<0.001). Specifically, dentists preferred security guarantees from local government (OR = 4.87, p<0.001). Both groups valued having an official residence (OR=3.6, p<0.001) as a factor for retention in remote areas. Scholarship, security guarantees, housing facilities, and medical facilities were the most considered factors for retaining doctors and dentists in a remote area. This study confirms the importance of a combination of interventions in maintaining doctors and dentists in remote areas. Policy options in the form of non-financial and financial intervention packages can be combined to improve their retention.

Difficulties of nurses and midwives in caring for refugee mothers: A qualitative study

ObjectiveThe aim of the study was to describe the difficulties of nurses and midwives experience in caring for refugee mothers in obstetrics and gynecology clinics. MethodsThis study had a descriptive phenomenological approach. Between 1 September 2020 and 1 April 2021, data were collected from 6 nurses and 7 midwives working in obstetrics and gynecology clinic who had previous experience in caring for refugee mothers. The data were collected through in-depth semi-structured interviews. Consolidated criteria for reporting qualitative research checklist were used in the reporting of the study. ResultsTwo themes and five subthemes emerged from the qualitative analysis. The first of the two themes identified was difficulties with cultural differences, which had the sub-themes of preference for female doctors or interpreters and harmful cultural practices. The second theme was difficulties with communication, which consisted of three subthemes, namely, taking anamnesis, giving nursing/midwifery care, and giving education. ConclusionIt is very important to determine the difficulties experienced by nurses and midwives while caring for refugee women to increase the quality of health services and to find solutions.

Study of physicians' preferences for optimizing the pharmacy assortment of glocose-lowering drugs

For the stable operation of the pharmacy and the proper support of patients with diabetes, it is necessary to optimize the assortment of glucose-lowering drugs (GLD), taking into account the significant prevalence of this disease. The demand for prescription drugs is formed by doctors who choose therapy and prescribe drugs.&#x0D; The purpose of this study was to determine the factors that influence of choosing GLD for the treatment of type 2 diabetes and the preferences of doctors when choosing GLD for therapy.&#x0D; They used a remote questionnaire form using Google forms. 732 doctor questionnaires were processed. Statistical processing was carried out using structural, comparative and graphic analysis.&#x0D; A survey of doctors established the factors that influence the prescription of drugs for the treatment of type 2 diabetes: high effectiveness and inclusion of drugs in treatment standards, their safety, and their own positive experience in prescribing drugs. It was also found that when choosing a GLD type, almost half of doctors take into account the patient's purchasing power and the presence of a GLD in the reimbursement program. The survey showed that a third of doctors prefer domestic GLD, and half of the respondents do so sometimes. When choosing foreign medical medications, doctors prefer German, French, and Swiss-made medical drugs. A significant part of doctors do not have preferences when choosing trade name (TN), but the majority of doctors who have preferences prefer TN mainly of foreign production and prolonged forms. It was found that about 10% of the responding doctors do not prescribe combined GLD. The majority of respondent doctors have preferences for combinations: metformin/glimepiride, dapagliflozin propanediol/metformin and sitagliptin/metformin. Problems have been identified at the stage of pharmacological supervision of GLD. Despite the fact that doctors noted in their practice the side effects of drugs in patients, only a fourth (22.7%) of respondents recorded these effects in accordance with the current legislation and made reports.&#x0D; It is advisable to use the results of the questionnaire to improve the care of patients with diabetes and to meet their needs by optimizing the pharmacy assortment.&#x0D; It is advisable to increase the list of International Nonproprietary Name of GLDs for reimbursement, which will contribute to the availability of modern treatment regimens, because the price of medicines limits the quality of modern treatment regimens for type 2 diabetes.

Preferences for training needs of village doctors in China: a systematic review.

Village doctors, as gatekeepers of the health system for rural residents in China, are often confronted with adversity in providing the basic public healthcare services. We sought to summarize the training contents, training method, training location, and training costs most preferred by village doctors in China and hope to provide evidence and support for the government to deliver better training in the future. Eight databases were searched to include studies that reported on the training needs of village doctors in China. We undertook a systematic review and a narrative synthesis of data. A total of 38 cross-sectional studies including 35,545 participants were included. In China, village doctors have extensive training needs. "Clinical knowledge and skill" and "diagnosis and treatment of common disease" were the most preferred training content; "continuing medical education" was the most preferred delivery method; above county- and county-level hospitals were the most desirable training locations, and the training costs were expected to be low or even free. Village doctors in various regions of China have similar preferences for training. Thus, future training should focus more on the training needs and preferences of village doctors.

Preferences for Rectal Sexually Transmitted Infection Sample Collection and Sexual Behaviors Among Adolescent and Young Adult Women Accessing Primary Care Services.

High prevalence of asymptomatic rectal chlamydia and gonorrhea among women is increasingly recognized. Screening is controversial because of lack of natural history data. Barriers to screening may include reluctance to discuss anal sex and collect rectal samples. This study describes the prevalence of sexual contact exposing adolescent and young adult women to extragenital sexually transmitted infections and acceptability of self-collection and clinician collection of rectal samples, preference for self- versus clinician-collected rectal samples, and preference for home or doctor's office for sample collection. Participants were recruited from a primary care office and completed structured interviews assessing types of sexual contact and attitudes about rectal sampling. Differences were tested using χ2 and 2-sided Fisher exact test. Of 110 cisgender women (aged 14-22 years) enrolled, the average age was 18.4 years (SD, 1.7 years), 83% reported a history of extragenital contact, 22% reported history of receptive anal intercourse. A majority of participants reported self- and clinician-collected rectal samples to be acceptable (86% and 73%, respectively), with preferences for self-collection (71%) over clinician collection (29%, P < 0.001) and collection at the doctor's office (85%) over home (15%, P < 0.001). Adolescent and young adult (AYA) women engage in behaviors that increase the risk of rectal sexually transmitted infection (STI). Self- and clinician-collected rectal samples were acceptable. A majority of AYA women preferred to collect rectal samples in the doctor's office rather than at home. This may reduce adolescents' access to direct-to-consumer STI services. Offering in-clinic, self-collected rectal samples may improve uptake of rectal STI screening in adolescent girls.

Trust in cancer information and source preference in later life

Objective: To examine the association between older adults’ trust in cancer information and their preference for sources of this type of information. Design: Cross-sectional study. Setting: The USA. Method: The data were obtained from Health Information National Trends Survey 5 Cycle 4 (2020). The sample included older Internet users ( N = 1,223). Results: Higher trust in cancer information from doctors and from religious organisations and leaders, as well as lower trust in cancer information from government health agencies and charitable organisations related to a greater preference for doctors. Greater preference for the Internet was a function of lower trust in cancer information from doctors and higher trust in cancer information from government health agencies. Finally, lower trust in cancer information from doctors and higher trust in cancer information from charitable organisations were associated with greater preference for cancer organisations as a primary source of cancer information. Conclusion: The results imply that doctors represent an source of cancer information, trust in which plays an important role with respect to preference for other sources. The results generally suggest that the trust older adults put in cancer information from different sources appears as a major predictor of their preference for the source of this information.

Effect of social media on doctor preference among rhinoplasty candidates

Objectives: The aim of this study was to investigate the effect of social media on doctor preference in rhinoplasty patients. Patients and Methods: This retrospective study was carried out on patients who came with the desire to have rhinoplasty between January 1, 2022, and October 31, 2022, in the clinic of a surgeon experienced in rhinoplasty and actively using social media. A questionnaire was applied to the patients to evaluate the doctor preference. The patients were asked how they discovered the physician and presented with four options: “social media-internet,” “social environment-advice,” “I am a former patient,” or “another physician referred me.” Results: Two hundred sixteen patients (145 females, 71 males; mean age: 32.9 years; range, 14 to 76 years) were included in the study. Of the patients, 23.1%, 62.5%, 4.6%, and 9.7% chose social media-internet, social environment-recommendation, I am a former patient, and another physician referred me, respectively. Statistically, it was seen that the effect of social environment on doctor preferences was significantly higher than the others (p&lt;0.01). Conclusion: The social environment is more effective in the physician preference of rhinoplasty patients than other factors. Instead of relying completely on social media, employing an aggressive advertising approach, and putting patients into unrealistic expectations, time should be provided to the previously operated patients for them to express their satisfaction to their acquaintances.

Study of the preferences of doctors and pharmacists regarding medicines for the treatment of diseases of the peripheral nervous system

The aim of the work is to assess the preferences of doctors and pharmaceutical workers regarding drugs for the treatment of diseases of the peripheral nervous system in order to optimize the medical supply of the population. Materials and methods. Data from the State Register of Medicines of Ukraine, Compendium-online, questionnaires of neurologists and pharmaceutical workers were used in this research. The search systematic, analytical, qualimetric, comparative, statistical analyses were used in the work. Results. The results of a survey of neurologists revealed that for the treatment of diseases of the peripheral nervous system (radiculopathy, radiculalgia) the most effective treatment regimen is that, which includes “Nucleo CMF Forte”, “Celtican” and “Myelofan”. The effectiveness and safety of the studied drugs were confirmed by qualimetric analysis. However, the results of consumer surveys showed that the latter prefer a treatment regimen that contains “Dicloberl”, “Ketanov” and “Dexalgin”. These drugs are the most irrational in terms of side effects and contraindications. For consumers, the importance of the pharmacological effect outweighs the effects on the body from the side effects of drugs. Conclusions. The study of the preferences of doctors and pharmacists regarding medicines for the treatment of radiculopathy and radiculalgia was conducted. The most rational treatment regimens are identified, the effectiveness of which is confirmed by the method of qualitative analysis.

Drucebo effect in statin therapy: more attributable to the patient, the doctor, or the mass media?

Abstract In recent years, the term “drucebo effect” (drug + nocebo) has been coined to mean the nocebo effect attributable more to the patient's expectations, the doctor's preferences and the interference of the mass media rather than the actual pharmacological effect [1,2]. We evaluated this effect over the last 10 years in 9,605 outpatients treated with statins, in primary (27%) and secondary (73%) prevention. Statin intolerance was reported in 1,729 patients (18%) with discontinuation of therapy for 5 days to 4 weeks. The table shows the causes of the presumed intolerance. In patients with muscular symptoms we calculated the related SMIS (Statin Myalgia Index Score) [3]. Patients with myalgia with or without CPK elevation and probable or possible SMIS were advised to halve the statin dose and reassess after 2–4 weeks. With persisting symptoms, the statin was changed. If symptoms persisted also with the second statin, the patient was advised to take the drug every other day. In case of unlikely SMIS, the decision to resume statin therapy was shared with the patients, with an accurate counseling, informing them of the important benefits of statins regarding mortality and morbidity. Probable true statin intolerance was found in 576 patients (6% of the overall statin therapy population: 332 with myalgia with or without CPK elevation and SMIS probable, 152 with myalgia and CPK elevation with SMIS possible, 46 with asymptomatic elevation of CPK, 15 transaminases increase, 21 with general malaise, 10 with severe depression). In 12% of patients, on the other hand, the interruption is attributable to a nocebo effect due both to the patient and both to the treating physician or other specialist, inclined to attribute the unwanted symptoms more to the drug than to other factors or to consider it non-modifiable by changing statin or doses. The Influence of the mass media is significant, too, and it is difficult to distinguish a greater responsibility of one or the other. Conclusions in patients treated with statins a drucebo effect is attributable in part to the patient, in part to the doctor and to the mass media, which tend to attribute the symptoms (especially of muscle origin) to the treatment and to interrupt the therapy without take into account the clear benefits regarding reduction of mortality and morbidity [4]. In our study, a probable true intolerance to statins is found in about one third of patients who report symptoms of a presumed intolerance. Funding Acknowledgement Type of funding sources: None.

Fuzzy constraint-based agent negotiation framework for doctor-patient shared decision-making

BackgroundThe clinical practice of shared decision-making (SDM) has grown in importance. However, most studies on SDM practice concentrated on providing auxiliary knowledge from the third-party standpoint without consideration for the value preferences of doctors and patients. The essences of these methods are complete and manual negotiation, and the problems of high cost, time consumption, delayed response, and decision fatigue are serious.MethodsIn response to the above limitations, this article proposes a fuzzy constraint-directed agent-based negotiation and recommendation framework for bilateral and multi-issue preference negotiation in SDM (PN-SDM). Its purpose is to provide preference information and intellectualize PN-SDM to promote SDM practice. We modeled PN-SDM problems as distributed fuzzy constraint satisfaction problems and designed the doctor agent and patient agent to negotiate on behalf of the doctor and patient. The negotiation result was then transformed into treatment plans by the recommendation model. The proposed negotiation and recommendation models were introduced in detail by an instance.ResultsThe proposed method with different strategies and negotiation pairs achieves good performance in terms of negotiation running time, negotiation rounds, and combined aggregated satisfaction value. Specifically, it can feasibly and effectively complete multiple rounds of PN-SDM in a few seconds and obtain higher satisfaction.ConclusionThe experimental results indicate that the negotiation model can effectively simulate preference negotiation and relieve the pressure of increasing issues. The recommendation model can assist in decision-making and help to realize SDM. In addition, it can flexibly cope with various negotiation scenarios by using different negotiation strategies (e.g., collaborative, win–win, and competitive).

Do doctors preferring forceps encounter more obstetric anal sphincter injuries: A retrospective analysis.

Obstetric anal sphincter injuries (OASIS) is a hospital-acquired injury and can affect a woman's quality of life with problems such as anal incontinence, perineal pain, dyspareunia, mental health, psychosexual issues, and concerns about future childbirth choices. The aim of this study was to determine whether there is a correlation between a doctor's preference for instruments, their individual OASIS rate and whether factors such as their fully dilated caesarean section rate, rate of double instrumental and seniority, influences their individual rate of OASIS. A population-based retrospective cohort study was performed on 1340 term nulliparous women with singleton pregnancies who underwent an instrumental delivery or fully dilated caesarean section. A survey of doctors involved in these deliveries was performed. The risk of OASIS was analysed for maternal age, ethnicity, birth position, level of training and doctor's instrument preference using a generalised linear mixed model. Doctors' instrument preferences were established in two ways: a self-reported survey and data-inferred preference based on the most used instrument per doctor. The OASIS rate for individual doctors was calculated. The overall risk of OASIS is higher for forceps compared to vacuum deliveries. Doctors with a preference for forceps compared to vacuum, correlated with both a lower OASIS rate and a higher fully dilated caesarean section rate. Doctors preferring forceps report a lower OASIS and higher fully dilated caesarean section rate. Doctors preferring vacuum must consider carefully whether forceps should follow if a vacuum fails as OASIS is more likely to occur.

Australian cardiac sonographers' use of industry guidelines when performing a transthoracic echocardiogram

AbstractIntroductionClinical practice guidelines (CPG) are a component of evidence‐based practice allowing standardisation across departments and individuals' skill levels. Australian Cardiac Sonographers (ACS) are not obliged to follow specific CPG when performing a transthoracic echocardiogram (TTE). This research aimed to determine guidelines/workplace protocols ACS follow when performing a TTE, and what attitudes, subjective norms and perceived behavioural controls exist that may prevent adherence to guidelines.MethodsA national mixed methods online survey, exploring adherence to and opinions of guideline use when performing a TTE. The ‘Theory of Planned Behaviour’ model (attitudes, subjective norms and perceived behavioural controls) was used to develop the survey.ResultsOf n = 131 ACS, 73% reported following a mix of guidelines, practice protocol and doctor preference when performing TTE. The majority followed the American Society of Echocardiography (ASE) guidelines (59%), considered guidelines beneficial (84%) and felt encouraged to adhere to them (56%). Most however (61%) reported finding measurement or pathology discrepancies with their own TTE studies compared with those performed at other practices. Factors negatively influencing guideline adherence included insufficient guideline education, time constraints for scanning and education, leadership influence and lack of quality control. These factors were considered largely workplace dependant.ConclusionWhile the majority of ACS do not follow a single specific guideline when performing a TTE, ACS believe guidelines are important. Several negative influences may prevent adherence in different workplace environments. Further examination of national standardisation and education/quality control programs is recommended with observation of patient and economic outcomes.

How do we manage asthma? Assessment of knowledge, attitude, and practice patterns among pulmonologists and allergists

Objective: The objective of this study was to evaluate and compare knowledge, attitude, and practice patterns between pulmonologists and allergists for adult asthma in Turkey. Methods: Questionnaire-based data were gathered from 236 pulmonologists and 62 allergists, who had been members of the Turkish Thoracic Society and Turkish National Society of Allergy and Clinical Immunology in January–March 2021. Univariate and multivariate statistics were used to determine the factors associated with primary reliever preferences. Results : Of the 298 physicians, 39% encountered at least five asthma patients daily. Spirometer was used frequently by both the allergists (82.3%) and pulmonologists (77.5%) for asthma diagnosis. Budesonide was the most preferred inhaler corticosteroid. Formoterol/budesonide was the most preferred ICS/LABA combination, followed by beclomethasone/formoterol and fluticasone/salmeterol for asthma treatment. For mild asthmatics, formoterol/ICS was the most preferred (72.6%) reliever among allergists, whereas salbutamol was the most preferred (66.1%) among pulmonologists (p < 0.001). Age and workplace were associated with salbutamol preference of doctors for mild asthmatics. Age, specialty, and patient examination time were significantly associated with salbutamol preference for severe asthmatics. Conclusions : The use of diagnostic tools, such as a spirometer, for asthma diagnosis was compatible with the guidelines. While recent updates of the guidelines indicate that salbutamol should not be used solely in mild asthmatics due to its harmful effects in long-term use, it still was the most preferred drug by pulmonologists. Postgraduate education programs are needed to improve compliance with the guidelines.

Current management of renal colic across Europe and its compliance to the European Association of Urology Guidelines on Urolithiasis: a survey from the European Section of Uro-technology, European Section of Urolithiasis, Young Academic Urologists study groups.

IntroductionRenal colic due to ureteral stones represents the primary acute condition in urology. Although guideline recommendations are available the institution, urologist, and patient preferences in diagnosis and treatment may differ. We aimed to evaluate the adherence of different European countries to the European Association of Urology (EAU) guidelines of urolithiasis and demonstrate trends in diagnostic and treatment approaches.Material and methodsWe used a survey including 33 questions clustered in four sections. The survey was circulated to the representatives of the main urological centers in Europe using the European Section of Uro-technology (ESUT), the European Section of Urolithiasis (EULIS), the Young Academic Urologists (YAU), and the European Urology Residents Education Programme (EUREP) mailing lists. The first section included participant and institution demographics, the second assessed the common diagnostic and treatment pathways, the third discussed the advantages and disadvantages of treatment strategies and the fourth investigated treatment preferences in different clinical scenarios. A descriptive analysis was performed.ResultsOf all participants, 84.21% stated that their departments follow specific guidelines, with no significant differences between institutions (p = 0.18). Preferred treatment practice difference in the case scenarios was significantly influenced by the Department bed capacities (p = 0.01), and complications varied between institutions (p = 0.02). Interestingly, 37–45% of participants were unaware of the different treatment costs.ConclusionsAlthough urologists generally decide according to local or international guidelines when approaching renal colic patients, there are deviations in clinical practice due to ‘doctor preference’ and ‘bed availability’. Many urologists are unaware of treatment costs.

Won't you stay just a little bit longer? A discrete choice experiment of UK doctors’ preferences for delaying retirement

Introduction and aimsHealth systems around the world face difficulties retaining their workforce, which is exacerbated by the early retirement of experienced clinicians. This study aims to determine how to incentivise doctors to delay their retirement. MethodsWe used a discrete choice experiment to estimate the relative importance of job characteristics in doctors’ willingness to delay retirement, and the number of extra years they were willing to delay retirement when job characteristics improved. 2885 British Medical Association members aged between 50 and 70 years, registered with the General Medical Council, practising in Scotland (in December 2019), and who had not started to draw a pension were invited. We compared the preferences of hospital doctors (HDs) and general practitioners (GPs). ResultsThe response rate was 27.4% (n = 788). The number of extra years expected to work was the most important job characteristic for both respondents, followed by work intensity for GPs, whereas working hours and on-call were more important for HDs. Personalised working conditions and pension taxation were the least important characteristics for both groups. Setting all characteristics to their BEST levels, GPs would be willing to delay retirement by 4 years and HDs by 7 years. ConclusionsCharacteristics related to the job rather than pension could have the greatest impact on delaying retirement among clinicians.

Abstract 13604: Patient Centered Prescription Using Optimization Algorithms for Statin Users

Introduction: Clinical decision support (CDS) that does not optimize individual variability with best practice and treatment outcomes, cannot support patient-centered care. For example, a statin treatment CDS focused on cholesterol reduction without accounting for patient comorbidities, at risk lifestyle, or genetics, may well suggest a treatment that increases adverse effects, has a high cost, and has a low potential for improved outcome. We present a novel patient-centered decision support (PCDS) system for statin initiation that accounts for best practice and patient variation and ranks treatment options by their predicted ability to improve cardiac outcomes and reduce adverse effects for individual patients. Method: A total of 30 M de-identified claim records from 1.4 M adults receiving statin treatment over 1990-2020 are available in the OptumLabs® Data Warehouse and were used to train our counterfactual prediction algorithm. For a new patient, the PCDS system predicts LDL reduction, cardiac events, and other outcomes at 1 and 5 years, for every potential statin treatment. The PCDS then integrates doctor and patient preferences into a multi-objective optimization algorithm to generate a ranked list of treatment options. Conclusion: Our novel patient-centered decision support (PCDS) adds sophisticated AI modeling and optimization to account for evidenced-based best practice, patient variability, and adverse effect risk to produce a clear ranking of treatment options that can be re-ranked upon input of patient preferences and provider’s lifestyle, socioeconomics, culture, experience and environment factors. This PCDS approach leverages traditional CDS adjusted to individual preferences to aligned with the patient-centered care model.