Onaisi Racha, Bezzazi Anaïs, Berthouin Thomas, Boulet Justine, Hasselgard-Rowe Jennifer, Maisonneuve Hubert
Department of General Practice, University of Bordeaux, F-33000 Bordeaux, France.
University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France.
Fam Pract. 2025 Apr 12;42(3). doi: 10.1093/fampra/cmad068.
A better understanding of the determinants involved in general practitioners' (GPs) decision-making processes when it comes to prescribing statins as primary prevention in patients with multimorbidity could provide insights for improving implementation of primary prevention guidelines.
We conducted a qualitative study using a deductive framework-based and inductive analysis of GPs' semi-structured interviews verbatim, from which expertise profiles of prescribers were also drawn. The analytical framework was built from a pragmatic synthesis of the evidence-based medicine, Modelling using Typified Objects (MOT) model of clinical reasoning processes, Theoretical Domains Framework, and shared decision-making frameworks.
Fifteen GPs were interviewed between June 2019 and January 2020. Diabetes seemed to represent a specific motivation for deciding about statin prescription for primary prevention purposes; and in situations of multimorbidity, GPs differentiated between cardiovascular and non-cardiovascular multimorbidity. Expert prescribers seemed to have integrated the utilisation of cardiovascular risk calculation scores throughout their practice, whereas non-expert prescribers considered them difficult to interpret and preferred using more of a "rule of thumb" process. One interviewee used the risk calculation score as a support for discussing statin prescription with the patient.
Our results shed light on the reasons why statins remain under-prescribed for primary prevention and why non-diabetic multimorbid patients have even lower odds of being prescribed a statin. They call for a change in the use of risk assessment scores, by placing them as decision aids, to support and improve personalised shared decision-making discussions as an efficient approach to improve the implementation of recommendations about statins for primary prevention.
在为患有多种疾病的患者开具他汀类药物进行一级预防时，更好地理解全科医生（GP）决策过程中的影响因素，可为改进一级预防指南的实施提供见解。
我们进行了一项定性研究，采用基于演绎框架和归纳分析的方法，逐字记录全科医生的半结构化访谈内容，并从中得出开药者的专业特征。分析框架是基于循证医学、临床推理过程的典型对象建模（MOT）模型、理论领域框架和共同决策框架的实用综合构建而成。
在2019年6月至2020年1月期间，对15名全科医生进行了访谈。糖尿病似乎是决定开具他汀类药物进行一级预防的一个特殊动机；在患有多种疾病的情况下，全科医生区分了心血管疾病合并症和非心血管疾病合并症。专家开药者似乎在整个实践中都综合运用了心血管风险计算评分，而非专家开药者认为这些评分难以解读，更喜欢采用更多的“经验法则”方法。一名受访者将风险计算评分用作与患者讨论他汀类药物处方的依据。
我们的研究结果揭示了他汀类药物在一级预防中处方率仍然较低的原因，以及非糖尿病多种疾病患者开具他汀类药物的几率甚至更低的原因。这些结果呼吁改变风险评估评分的使用方式，将其作为决策辅助工具，以支持和改进个性化的共同决策讨论，作为一种有效方法来改善关于他汀类药物一级预防建议的实施。
