Physician Beliefs Research Articles

Gaps in beliefs and practice in dyslipidaemia management in Japan, Germany, Colombia and the Philippines: insights from a web-based physician survey

BackgroundImplementing evidence-based management of dyslipidaemia is a challenge worldwide.ObjectivesTo understand physician beliefs and behaviour and identify uncertainties in dyslipidaemia management across four world regions.MethodsWeb-based survey of 1758 physicians in Japan, Germany, Colombia and the Philippines who were selected randomly from existing databases. Key inclusion criteria were 1) for cardiologists and diabetes/endocrinology specialists: ≥50 dyslipidaemia patients examined in the last month; 2) for specialists in neurology/neurosurgery/stroke medicine: ≥50 dyslipidaemia patients and ≥ 20 patients with a history of ischaemic stroke examined in the last month; and 3) for specialists in nephrology and general medicine: based at centres with ≥20 beds and ≥ 50 dyslipidaemia patients examined in the last month. The self-report survey covered dyslipidaemia management, target low-density lipoprotein cholesterol (LDL-C) levels in different patient groups, and statin safety. All physicians gave voluntary consent and all data were anonymised. Analysis was solely descriptive.ResultsThe survey highlighted key areas of uncertainty in dyslipidaemia management in the four countries. These related to LDL-C targets in different patient groups, the safety of low LDL-C levels, the safety of statins, especially for effects on cognitive, renal and hepatic function and for haemorrhagic stroke risk, and lipid management strategies in patients with chronic kidney disease, including those with concomitant hypertriglyceridaemia.ConclusionsThis survey of physicians in Japan, Germany, Colombia and the Philippines has identified key gaps in knowledge about dyslipidaemia management. These relate to the safety of low LDL-C levels, the safety of statins, and lipid management of chronic kidney disease. The findings from this survey highlight the need for further education to improve the implementation of guideline recommendations for dyslipidaemia management.

Psychodermatology in clinical practice: An examination of physician attitudes, beliefs, and interventions toward psychocutaneous disease.

Fifteen days postconception, the embryonic ectoderm simultaneously gives rise to the central nervous system and the epidermis of the integumentary system. The connections between the two organ systems manifests in both the psychiatric and dermatologic setting. To examine the current awareness of psychiatric comorbidity in dermatologic practice and its management in a sample of dermatologists across the United States. A survey was conducted that explored physician perspective on psychiatric comorbidity, clinical practice, and management, that is, use of survey screening measures, employment of psychological interventions, and coordination with mental health services. SPSS v25 was used for descriptive statistical analysis and to calculate Pearson's correlation coefficients between familiarity with dermatologic/psychiatric comorbidity and its management. Ninety-eight percentage of respondents believed a relationship between mental and dermatological health. 61.7% of respondents reported seeing patients with known psychological problems more than once a week. The administration of a psychiatric questionnaires was noted in 23% of practices and only 6.38% administer the questionnaire at every appointment. Management of comorbid disease is best done through the collaboration of dermatology and psychiatry. Implications for streamlining practice include the routine administration of quality of life surveys, utilization of brief psychotherapeutic strategies, and regular interdisciplinary referrals.

Proper Disposal of Prescription Opioids in Southwest Virginia: Assessment of Patient, Physician, and Medical Student Beliefs and Practices.

Southwestern Virginia demonstrates the highest regional mortality rate from prescription opioid overdoses. Nationally, 65% of patients misusing opioid medications received them from friends and family, underscoring the need for effective disposal of unused narcotics. (1) To understand patient, provider, and medical student beliefs and misconceptions regarding proper methods of opioid disposal; (2) to characterize discrepancies that exist between patient self-reported habits and medical student/provider perceptions of opioid usage, disposal, and diversion. Descriptive, cross-sectional, observational study. Large, nonprofit health care organization and allopathic medical school in Southwestern Virginia. All ambulatory patients 18 years or older presenting for elective consultation at health system orthopedics department; all institutionally employed physicians with active system e-mail addresses; and all current students at the associated medical school. Patients: The number who had received information regarding proper methods of opioid disposal, intended disposal method, methods of disposal considered appropriate, comfort level with opioid disposal, and demographic data. Physicians and Medical Students: The number who had received instruction regarding proper methods of opioid disposal, acceptable means of opioid disposal, most appropriate disposal method, disposal method most likely to be employed by patients, practice profile/prescribing data, and medical school year. In total, 64% of patients (n = 255/750) had never received instruction from a physician regarding opioid disposal; 56% of physicians (n = 212/732) and 78% (n = 80/171) of medical students indicated that they never received formal instruction regarding methods of disposal. The majority of physicians believed that their patients are most likely to use in-home methods of disposal or store prescription medications for future use; 61% of patients indicated a preference for accessible disposal facilities. The discrepancy between patient and physician responses highlights a lack of communication regarding disposal of unused opioid medications and is a target for future intervention.

Comparison of Clinical Psychologist and Physician Beliefs and Practices Concerning Malingering: Results from a Mixed Methods Study

Malingering, or intentional feigning of impairment for an external incentive, has been the topic of extensive psychological research in recent decades. The emphasis on symptom validity assessment in training, practice, and research in clinical psychology is not echoed across other health professions. While past surveys of clinical psychologists revealed positive beliefs and attitudes toward validity assessment, much less is known about physicians in this area, particularly in regard to how they identify suspected malingering. To address this gap, we surveyed a sample of demographically similar clinical psychologists (n = 57) and physicians (n = 54) regarding their beliefs and practices about malingering. Unique to this study was the use of a mixed survey and mixed methods approach to analyzing quantitative and qualitative data. Broadly, survey findings indicated that more clinical psychologists reported documenting malingering in their careers compared with physicians (65.0% vs. 33.0%). Consistently, more clinical psychologists endorsed “always” or “often” being able to recognize malingering compared with physicians (73.7% vs. 22.2%). Clinical psychologists indicated that they ask patients or evaluees about potential external incentives (e.g., current involvement in litigation) much more often than physicians (70.0% vs. 16.0%). On average, clinical psychologists estimated higher base rates of malingering in six high-risk malingering diagnostic categories compared with physicians, with greatest estimation difference noted for mild traumatic brain injury (19.9% vs. 5.9%). Qualitative examination of respondent data generally converged with quantitative findings and provided additional insights to how conceptualizations of malingering differ across healthcare disciplines. Implications for practice and study limitations are discussed.

A system uptake analysis and GUIDES checklist evaluation of the Electronic Asthma Management System: A point-of-care computerized clinical decision support system.

ObjectiveComputerized clinical decision support systems (CCDSSs) promise improvements in care quality; however, uptake is often suboptimal. We sought to characterize system use, its predictors, and user feedback for the Electronic Asthma Management System (eAMS)—an electronic medical record system–integrated, point-of-care CCDSS for asthma—and applied the GUIDES checklist as a framework to identify areas for improvement.Materials and MethodsThe eAMS was tested in a 1-year prospective cohort study across 3 Ontario primary care sites. We recorded system usage by clinicians and patient characteristics through system logs and chart reviews. We created multivariable models to identify predictors of (1) CCDSS opening and (2) creation of a self-management asthma action plan (AAP) (final CCDSS step). Electronic questionnaires captured user feedback.ResultsOver 1 year, 490 asthma patients saw 121 clinicians. The CCDSS was opened in 205 of 1033 (19.8%) visits and an AAP created in 121 of 1033 (11.7%) visits. Multivariable predictors of opening the CCDSS and producing an AAP included clinic site, having physician-diagnosed asthma, and presenting with an asthma- or respiratory-related complaint. The system usability scale score was 66.3 ± 16.5 (maximum 100). Reported usage barriers included time and system accessibility.DiscussionThe eAMS was used in a minority of asthma patient visits. Varying workflows and cultures across clinics, physician beliefs regarding asthma diagnosis, and relevance of the clinical complaint influenced uptake.ConclusionsConsidering our findings in the context of the GUIDES checklist helped to identify improvements to drive uptake and provides lessons relevant to CCDSS design across diseases.

Quality antecedents and performance outcome of cloud-based hospital information system continuance intention

PurposeThis study's purpose is to propose an integrated model based on expectation-confirmation model (ECM), task-technology fit (TTF) model, and updated DeLone and McLean information system (IS) success model to examine whether quality factors and TTF as antecedents to physician beliefs can affect physicians' continuance intention of the cloud-based hospital information system (HIS) and performance impact.Design/methodology/approachSample data for this study were collected from physicians at five hospitals in Taiwan. A total of 500 questionnaires were distributed, and 305 (61.0 percent) usable questionnaires were analyzed using structural equation modeling in this study.FindingsThis study verified that physicians' perceived information quality, system quality, general technical support service quality, and cloud storage service quality all positively caused their PU, confirmation, and perceived TTF in the cloud-based HIS, which together explained their satisfaction with the system, and subsequently led to their continuance intention of the system and performance impact.Originality/valueFirst, IS-related and cloud-related quality factors are simultaneously taken into consideration within this study's research model, and empirical results reveal deep insights into quality evaluation in the field of physicians' cloud-based HIS continuance intention. Next, this study contributes to an understanding of TTF in explaining physicians' cloud-based HIS continuance intention that is difficult to explain with only their utilitarian perception of the system, and places emphasis upon physicians' perception of performance impact greatly driven by their perceived TTF and continuance intention of the system, thus the results can shed light on antecedents and outcome of physicians' cloud-based HIS continuance intention.

Measuring the impact of the French version of The Whiplash Book on both treatment approach and fear-avoidance beliefs among emergency physicians. A cluster randomized controlled trial.

BackgroundWhiplash-associated disorders have been the subject of much attention in the scientific literature and remain a major public health problem.ObjectiveMeasure the impact of a validated information booklet on the fear-avoidance beliefs of emergency physicians and their approach to management regarding the treatment of whiplash-associated disorders.MethodsA prospective cluster randomized controlled study conducted with a sample of emergency medicine physicians. Fear-avoidance beliefs were measured using The Whiplash Belief Questionnaire (WBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ). We assessed the approach to management based on the prescription of pharmacological and non-pharmacological treatments based on the advice given to patients. The validated information booklet was the French version of The Whiplash Book. A set of questionnaires was sent to participants pre- and post-intervention. The experimental intervention was the provision of The Whiplash Book. The control arm did not receive any training or information.ResultsMean fears and beliefs scores on inclusion were high: WBQ = 19.09 (± 4.06); physical activity FABQ = 11.45 (± 4.73); work FABQ = 13.85 (± 6.70). Improvement in fear-avoidance beliefs scores being greater in the intervention group was further confirmed by the variation in WBQ (-20 [-32; -6] vs. -6 [-16; 9]; p = 0.06), physical activity FABQ (-70 [-86; -50] vs. -15 [-40; 11]; p < 0.001), and work FABQ (-40 [-71; 0] vs. 0 [-31; 50]; p = 0.02). The emergency physicians' initial approach to management was not consistent with current guidelines. Reading the French version of The Whiplash Book could contribute to changing their approach to management in several areas on intra-group analysis.ConclusionThe French version of The Whiplash Book positively influenced fear-avoidance beliefs among emergency physicians.

Perceptions and Beliefs Regarding NSAIDs in the Asia-Pacific Region.

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of pain and inflammation. However, chronic NSAID use may result in gastrointestinal (GI), cardiovascular (CV), renal or other safety concerns, especially in high-risk populations. The aim of this review is to systematically identify relevant literature and to organize available evidence for perceptions or beliefs of physicians and patients about the safety and efficacy of NSAIDs.MethodsA systematic literature search was conducted in MEDLINE® (through PubMed®), Embase® (through Ovid®), and the Cochrane Library. Additional unstructured searches were conducted using Google Scholar™ and Google. The scope of this study did not include grey literature searches or handpicking of cross references. This systematic analysis was conducted with a special interest in studies conducted in the Asia-Pacific (APAC) region and information related to the COX-2 (cyclooxygenase-2) selective inhibitors.ResultsOut of a total of 2822 studies retrieved from different databases (PubMed®, Cochrane, Google Scholar™ and Embase®), 99 (3.5%) met the inclusion criteria. Further, out of these 99 studies, 23 APAC region studies were analyzed. The common perceptions were related to GI, CV, renal and respiratory safety, efficacy and COX-2 inhibitors.ConclusionOverall, the level of awareness among patients regarding NSAIDs was observed to be considerably poor. Moreover, risk stratification by physicians must be practiced in order to decrease the incidence of adverse events.

Placebos in Australian general practice: A national survey of physician use, beliefs and attitudes.

International surveys indicate that placebo use by general practitioners (GPs) is remarkably high, but usage in Australia is currently unknown. To address this, the aim of this study was to examine rates of use and beliefs about placebos in Australian general practice. This study was conducted using a cross-sectional internet-based survey of a random sample of Australian GPs from a national database between February and April 2018. In total, 641 GPs opened the email invitation and 136 (18%) took part. Thirty-nine percent of GPs had used an inert placebo, and 77% had used an active placebo. GPs primarily used placebos because they believed placebos could provide genuine benefit and viewed themselves as having a strong role in shaping patients' expectations. Of concern, antibiotics were the most common type of active placebo prescribed. Placebo use by Australian GPs is fairly common, particularly the use of active placebos. Ethical issues surrounding the prescription of placebos in general practice are discussed.

Palliative sedation: beliefs and decision-making among Spanish palliative care physicians.

To describe physician attitudes to deep palliative sedation. A nationwide e-survey of Spanish palliative care specialists was performed using vignettes which described patients close to death with intractable symptoms. Sedation levels were defined according to the Richmond Agitation-Sedation Scale. Multivariate analyses were performed to assess the explanatory factors involved in decision-making. Responses of 292 palliative care specialists were analyzed (response rate 40%). Ninety-four percent, 87%, and 81% of the respondents supported the use of palliative sedation in cases of irreversible refractory symptoms as hyperactive delirium and dyspnea at rest secondary to lung cancer and GOLD stage IV COPD; 60% agreed with the use of palliative sedation in cases of existential suffering. Logistic regression analysis found as the explanatory factor in not performing palliative sedation the physicians' belief that sedation therapy constitutes undercover euthanasia (OR = 12, p < 0.01). Around 80% of physicians who decided on palliative sedation chose deep/complete sedation for every vignette; there were no common explanatory factors for decision-making for every vignette. The belief that sedation therapy equates to undercover euthanasia justifies not performing deep sedation in cases of irreversible refractory agitated delirium (OR = 7) and irreversible intractable dyspnea (OR = 6). Physician background in palliative care and sedation were associated with the selection of deep/complete sedation in cases of refractory delirium and cancer-associated dyspnea. Spanish palliative physicians generally agree with the use of deep sedation as a proportionate treatment in dying patients with refractory symptoms. Decision-making is associated with physician beliefs regarding euthanasia and with the physician's background in palliative care and sedation.

Challenges in Clinical Trial Implementation: Results from a Survey of the National Accreditation Program of Breast Centers (NAPBC).

Although the results of clinical trials often guide best practices, changing clinical practice based on clinical trial results can be challenging. The objective of this study was to examine provider-reported barriers to adopting best clinical practices according to clinical trial data. A cross-sectional survey was conducted of providers from the National Accreditation Program for Breast Centers about barriers that prevent the incorporation of trial findings. Descriptive analyses and multivariable analyses were performed to determine provider characteristics that were significantly associated with reported barriers. Overall, 383 institutions participated (63.5% response rate), with a total of 1226 physicians responding to the survey (80% response rate). Providers identified national guidelines and meetings as the most compelling way to receive practice-changing information. They reported the following internal barriers to trial implementation: patient preference (45%), strongly held beliefs by partners/colleagues (37%), and insufficient time to discuss new practices (30%). External barriers preventing trial implementation included a lack of agreement from multidisciplinary tumor boards (32%), fear of reimbursement loss (23%), and resistance from clinical staff (20%). Reported barriers differed by provider specialty, with plastic surgeons and radiation oncologists reporting that strongly held beliefs by partners/colleagues and disagreement from multidisciplinary tumor boards were the most significant factors preventing clinical trial implementation. Physician beliefs and patient preferences are the most frequently reported barriers to clinical trial implementation. Tactics to better educate providers about how to explain new clinical trial data to their patients and colleagues are needed.

The beliefs of Senegal's physicians toward the use of telemedicine.

IntroductionTelemedicine is seen as a potential solution to improve access to specialist services in underserved areas, but using telemedicine depends on physicians' beliefs regarding its use. Applying the theory of planned behaviour, there are three kinds of beliefs of relevance: behavioural, normative and control beliefs. This study aimed to determine the behavioural, normative and control beliefs of Senegal's physicians regarding the use of telemedicine.MethodsA qualitative descriptive study involving individual interviews with physicians was conducted between January and June 2014. It included 32 physicians working in public hospitals and 37 physicians working in district health centres. Interviews were taped, transcribed and their content coded thematically using the NVivo 10 software.ResultsThe most significant positive behavioural belief was that telemedicine makes experts' opinions accessible despite distance; the most important negative behavioural belief was that telemedicine can lead to medical errors. The positive normative belief mentioned most was that patients approve the use of telemedicine, but the negative normative belief mentioned most was that the patients would not approve it. The prevailing positive control belief was that physicians will use telemedicine if it is easy to use and the most cited negative control belief was that physicians will not use telemedicine if they have insufficient time.ConclusionThe results of this study provide a better understanding of the beliefs of Senegal's physicians regarding telemedicine, which can help in designing interventions to promote its use. Such interventions may help improve access to healthcare in rural areas.

Attitudes and beliefs of emergency physicians on lab tests utilization in clinical practice. A multicenter survey

It is commonly perceived that the main obstacle for an effective partnership between Emergency Medicine (EM) and Laboratory Medicine (LM) is the lack of reciprocal knowledge and understanding. A further aspect is a partial comprehension of clinical significance and implications of some tests. The real scenario of attitudes and beliefs of Emergency Physicians (EPs) on lab tests utilization in clinical practice remains largely unclear. Therefore, this original study was designed to explore this field of medical knowledge, by using a survey on attitudes and beliefs in laboratory diagnostics which was disseminated among many Italian EPs. A questionnaire containing 20 different items/statements was designed and then disseminated either directly, or in a digital format. Overall, 183 questionnaires were compiled and collected. The results of this nationwide survey seem to confirm the existence of a suboptimal knowledge of both clinical and economic impact of urgent laboratory tests by Italian EPs. An unsatisfactory relationship between EPs and laboratory professionals seems also to emerge. Several EPs attribute this to Shortage of time to think (18.6%), followed by Fair of medical-legal litigation (13.6%). On the other hand, interestingly, it also emerged that some Italian hospitals still include obsolete o redundant tests in panels of urgent laboratory analyses, potentially misleading for the diagnostic reasoning in the Emergency Department (ED). In conclusion, the virtuous circle between EM and LM should be further reinforced for optimizing clinical pathways in Italian EDs, improving clinical outcomes and reducing unnecessary expenditures. A major agreement between laboratory and emergency professionals

Barriers physicians face when referring patients to cardiac rehabilitation: a narrative review.

While cardiac rehabilitation (CR) has been shown to be a beneficial form of secondary prevention for patients with cardiovascular disease, barriers of referral to CR still exist for patients. Barriers that specifically make it difficult for physicians to make the referral could be worthwhile to examine. This narrative review hypothesizes that increasing awareness and education on the various aspects of CR as well as simplifying the referral process could lead to increased referral rates as they target physician-related barriers. This narrative review seeks to further understand the physician-related barriers of low CR awareness and hindering referral processes. A search in Scopus was conducted with preference for articles examining CR referral strategies used by physicians; physicians' awareness of CR programs; physicians' perceptions, beliefs, or knowledge of the benefits of CR; or physicians' experience with or understanding of the selection process of CR programs, including indications for referral. Two systematic reviews and two observational studies were selected for discussion. Three of the selected studies had findings supporting the notion that increasing physicians' awareness of CR could impact referral rates. One of the studies evaluated the perceptions that physicians and CR programs had on various referral strategies. While more study is needed to assess the actual level of knowledge and awareness physicians have regarding CR, this review supports using educational interventions as well as targeting various aspects of the referral process for improving referral rates.

Physician Beliefs About Online Reporting of Quality and Experience Data.

Physician attitudes about websites that publicly report health care quality and experience data have not been recently described. To examine physician attitudes about the accuracy of websites that report information about quality of care and patient experience and to describe physician beliefs about the helpfulness of these data for patients choosing a physician. The Rhode Island Department of Health (RIDOH) and a multi-stakeholder group developed and piloted two questions that were added to RIDOH's biennial physician survey of all 4197 practicing physicians in Rhode Island: (1) "How accurate of a picture do you feel that the following types of online resources give about the quality of care that physicians provide?" (with choices) and (2) "Which types of physician-specific information (i.e., not about the practice overall) would be helpful to include in online resources for patients to help them choose a new physician? (Select all that apply)." Responses were stratified by primary care vs. subspecialty clinicians. Summary statistics and chi-squared tests were used to analyze the results. Among 1792 respondents (response rate 43%), 45% were unaware of RIDOH's site and 54% were unaware of the Centers for Medicare & Medicaid Services (CMS)' quality reporting sites. Only 2% felt that Medicare sites were "very accurate" in depicting physician quality. Most physicians supported public reporting of general information about physicians (e.g., board certification), but just over one-third of physicians felt that performance-based quality measures are "helpful" (and a similar percentage reported that patient reviews felt are "helpful") for patients choosing a physician. Physician-respondents were either uninformed or skeptical about public reporting websites. In contrast to prior reports that a majority of patients value some forms of publicly reported data, most physicians do not consider quality metrics and patient-generated reviews helpful for patients who are choosing a physician.

Does Location of Practice or Religiosity Predict Negative Physician Attitudes or Beliefs Toward LGB+ Individuals?

The purpose of this study is to extend the Sabin et al's. (Am J Public Health 105(9):1831-1841, 2015. https://doi.org/10.2105/AJPH.2015.302631) findings to examine the extent to which religiosity and/or geographic region is predictive of negative attitudes or beliefs toward lesbian, gay, bisexual, and asexual (LGB+) individuals. Secondary data from the Sexuality Implicit Association Test were analyzed. Data included only participants from 2013 to 2015 who identified "Healthcare - Diagnosing and Treating Practitioners" as their occupation (n = 1376). The results of a factorial ANOVA revealed significant group differences accounting for 22.4% of the variance in attitudes toward LGB+ individuals. Religiosity was a significant factor in determining negative attitudes toward LGB+ individuals. However, the study was underpowered (5.8%) to detect an effect of geographic location in determining negative attitudes toward LGB+ individuals. It is important to validate a tool that can adequately measure the common assumptions associated with both religion and geographic region. Additionally, medical educators need to learn how to recognize and address negative attitudes among their students.

Differences in primary care providers’ and oncologists’ views on communication and coordination of care during active treatment of patients with cancer and comorbidities

Introduction Management of comorbid diseases in patients with cancer is often unclear. The purpose of our study was to identify differences and similarities between primary care providers and oncologists’ knowledge, attitudes, and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment. Methods We conducted a cross-sectional study using an anonymous self-administered survey which was available to approximately 600 providers in primary care and medical oncology practicing in both outpatient and inpatient settings from March to December 2014 at three academic hospitals in New York City (Mount Sinai Hospital, Mount Sinai Beth Israel, and Weill Cornell). Our survey instrument assessed physician knowledge, attitudes, and beliefs using a clinical vignette of a cancer patient undergoing active treatment. Descriptive statistics were used to summarize the demographic and practice details of survey responses, and univariate analyses were used to assess differences in responses between primary care providers and oncologists. Results The survey was completed by 203 providers, including 127 primary care providers (62.5%), 32 medical oncologists (15.8%), 11 palliative care physicians (5.4%), and 33 nurse practitioners or physician assistants (16.3%). Medical oncologists admitted more uncertainty regarding who should manage preventive care as compared to primary care providers (34.4% vs. 16.5%, p = 0.02), whereas primary care providers were more concerned about duplicated care (22.8% vs. 6.3%, p = 0.03). Both primary care providers and medical oncologists agreed that diabetes should be actively managed during cancer treatment. More primary care providers felt less strict glycemic control was allowable (56.8% vs. 37.5%, p = 0.05) and that it is allowable for patients to miss some diabetes-related visits (80.6% vs. 56.3%, p = 0.01). Discussion Primary care providers and medical oncologists differ in their knowledge, attitudes, and beliefs regarding coordination of care and management of comorbid conditions in patients undergoing cancer treatment. These differences reflect systemic challenges to provision of care to cancer patients and the need for a model of care coordination.

Stroke Prophylaxis for Atrial Fibrillation? To Prescribe or Not to Prescribe—A Qualitative Study on the Decisionmaking Process of Emergency Department Providers

Although clinical guidelines recommend oral anticoagulation for atrial fibrillation patients at high risk of stroke, emergency physicians inconsistently prescribe it to patients with newly diagnosed atrial fibrillation. We interview emergency physicians to gain insight into themes influencing prescribing of oral anticoagulation for patients discharged from the ED with new-onset atrial fibrillation. From September 2015 to January 2017, we conducted semistructured qualitative interviews with a purposeful sampling of18 ED attending physicians who had evaluated a patient with new-onset atrial fibrillation within the past 30 days. Interview promptsexamined physicians' attitudes toward prescription of oral anticoagulation therapy and current clinical guidelines. We used a constructivist grounded theory approach to analyze data and develop a theory on prescribing practices among emergency physicians. Three broad domains emerged from our analyses. (1) Oral anticoagulation prescribing practice: underlying themes affecting oral anticoagulation prescribing from the ED included physician practice patterns, beliefs, and barriers (including experience, comfort, and insurance coverage), and patient factors (including comorbidities, bleeding risk, and social concerns). Ultimately, these themes indicated physician discomfort and a sense of futility in prescribing oral anticoagulation for atrial fibrillation. (2) Guideline usage for oral anticoagulation prescribing: regardless of experience, most emergency physicians did not report using clinical guidelines when treating patients. (3) Recommendations for improved prescribing: physicians recommended the development of a validated, reliable, simple, accessible, and population-specific guideline that considers patient social factors. The decision to prescribe oral anticoagulation in the ED is complex. Improving guideline adherence will require a multifaceted approach inclusive of system-level improvements, physician education, and the development of ED-specific tools and guidelines.

Facilitators of and barriers to adopting a restrictive red blood cell transfusion practice: a population-based cross-sectional survey.

Despite recommendations for restrictive approaches to red blood cell transfusion in the intensive care unit (ICU), variation from best practices persists. The aim of this study was to explore potential facilitators of and barriers to practising a restrictive red blood cell transfusion strategy among intensive care physicians using the theoretical domains framework. We conducted an online population-based cross-sectional survey of all intensive care physicians in 1 health care system (Alberta). Survey questions were based on 6 key theoretical domains of the theoretical domains framework: Knowledge, Social/professional roles and identity, Motivation and goals, Beliefs about consequences, Social influences and Beliefs about capabilities. The survey was administered between July 27 and Oct. 6, 2017. Descriptive statistics (demographic and Likert scale data) and conventional content analysis (open-ended responses) were conducted. Forty-two intensive care physicians completed the survey (estimated response rate 56%). The respondents identified knowledge of published evidence, use of guidelines, improved outcomes, physician autonomy, and perceived culture of acceptance and collegial support as facilitators of practising a restrictive transfusion strategy. Identified barriers included potential impact on and cost to other clinical goals, conflicting practices and beliefs of physicians in other clinical specialties, deficits in medical trainees' skills and knowledge, and attitudinal barriers related to denial. Using the theoretical domains framework, we identified 9 key self-reported facilitators of and barriers to intensive care physicians' transfusion behaviour. Understanding these determinants will help inform development and implementation of interventions within ICUs to encourage optimal use of red blood cell transfusion practices for nonbleeding patients whose condition is stable.

Swiss gynecologists' opinions and perceptions concerning the use of intrauterine devices by nulliparous and multiparous women: an online survey study.

ObjectiveThe aim of this study was to 1) evaluate the Swiss physicians’ attitudes and beliefs on intrauterine device (IUD) use in multiparous and nulliparous women and 2) determine whether the woman’s parity was a factor influencing the gynecologists’ IUD practice.Material and methodsThe Global Survey questionnaire investigating IUD use was modified and adapted to the Swiss guidelines. A link to the online questionnaire was sent to gynecologists practicing in the French- and German-speaking parts of Switzerland. We defined IUD use as frequent whenever it was prescribed by gynecologists for 25% or more out of all women consulting for contraception.ResultsA total of 299/1,696 gynecologists completed the online questionnaire (17.6%). Frequent IUD prescription was found in 72.9% of multiparous and in 11.8% of nulliparous women. The most frequently reported barriers to IUD use in nulliparous women were as follows: concern over a painful insertion, difficulty of insertion, higher risk of perforation, pelvic inflammatory disease, changes in bleeding pattern, high cost, and risk of extrauterine pregnancy. The presence of such perceived obstacles was associated with less frequent IUD insertion in nulliparous women.ConclusionThe results of this study provide a valuable insight into the attitudes and opinions of Switzerland’s gynecologists on the use of IUDs in nulliparous and multiparous women, showing that the women’s parity is a factor influencing the physicians’ attitudes and opinions. Further health education might help minimize the physicians’ attitude discrepancies in IUD prescription to nulliparous and multiparous women.