Sheila Greenfield, Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Tel.: 0121 414 6493; fax: 0121 414 7938; e-mail: [email protected]

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Summary

Background and objective: There are variations between individual clinicians as to the thresholds at which preventive treatment for coronary heart disease (CHD) should commence. Patients’ decisions may be influenced by clinicians’ recommendations. Free text comments added by respondents to closed questionnaires may identify areas which are of real concern to them about the topic being studied. The study aimed to identify issues voluntarily raised by clinicians surrounding the decision to prescribe preventive treatment for CHD.

Methods: An analysis was undertaken of the free text comments made by cardiologists, general practitioners and practice nurses who responded to a closed question postal questionnaire in which they were asked to identify at which level of pretreatment risk they would offer treatment.

Results and discussion: A similar percentage of respondents in each professional group provided free text comments. Clinicians’ concerns centred on five main themes around prescribing decisions: the risks and benefits of treatment, the patient's role in treatment decisions, patient characteristics, costs to patients, and costs to the health services. Different issues may be of more concern to some professional groups than others.

Conclusion: In addition to the use of risk assessment tools and guidelines, clinicians’ actual prescribing behaviour may be influenced by more subjective factors. Patients at similar risk may receive different advice depending on the individual clinician they consult.

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Factors influencing clinicians’ decisions to prescribe medication to prevent coronary heart disease

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