Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
BMJ Open. 2024 Mar 20;14(3):e079668. doi: 10.1136/bmjopen-2023-079668.
Peripheral artery disease (PAD) is a major risk factor for cardiovascular morbidity and mortality, despite surgical and endovascular treatments. Emerging evidence supports the use of immediate antithrombotic medications after endovascular intervention for PAD, however, there is a lack of consensus regarding choice and duration of antithrombotic therapy. Prescriber decision-making is a complex process, with prior studies demonstrating patient factors can influence variability in antithrombotic therapy for PAD. However, it remains unclear the relative contribution of these factors. This paper describes a planned study that aims to (1) determine the influence of patient factors on clinician preference for antithrombotic therapy following endovascular intervention and (2) compare differences in prescribing preferences between consultant vascular surgeons and trainees.
This cross-sectional survey will evaluate antithrombotic prescribing choices using a discrete choice experiment (DCE) that has been developed and piloted for this study. A list of attributes and levels was generated using a mixed-methods approach. This included an extensive literature review and semistructured interviews with prescribing clinicians. Following final selection of included attributes, specialised software was used to construct a D-efficient design for the DCE questionnaire. The electronic questionnaire will be administered to vascular trainees and consultant surgeons across Australia. These data will be analysed using multinomial logistic regression, treating the decision to prescribe antithrombotic therapy as a function of both the attributes of the two alternatives, as well as characteristics of the respondent. Latent class analysis will be used to explore heterogeneity of responses.
Ethics approval was obtained from the University of Sydney Human Ethics committee (2023/474). The results of this study will be published in peer-reviewed journals and presented at national vascular surgical conferences. These results will be used to improve understanding how clinicians make prescribing decisions and to inform future strategy to enhance guideline-directed prescribing.
外周动脉疾病 (PAD) 是心血管发病率和死亡率的主要危险因素，尽管有外科和血管内治疗。新出现的证据支持在 PAD 的血管内干预后立即使用抗血栓药物，但关于抗血栓治疗的选择和持续时间仍缺乏共识。开处方的决策是一个复杂的过程，先前的研究表明，患者因素会影响 PAD 的抗血栓治疗的变异性。然而，这些因素的相对贡献仍不清楚。本文描述了一项计划中的研究，旨在：(1)确定患者因素对血管内干预后临床医生对抗血栓治疗偏好的影响；(2)比较顾问血管外科医生和受训者在处方偏好上的差异。
本横断面调查将使用离散选择实验 (DCE) 评估抗血栓药物的处方选择，该实验已为此研究进行了开发和试点。使用混合方法生成了属性和水平列表。这包括对文献的广泛回顾和对处方临床医生的半结构化访谈。在最终选择包括的属性后，使用专门的软件为 DCE 问卷构建了一个 D-有效的设计。电子问卷将在澳大利亚的血管受训者和顾问外科医生中进行管理。这些数据将使用多项逻辑回归进行分析，将开处方抗血栓治疗的决定视为两个替代方案的属性以及受访者特征的函数。潜在类别分析将用于探索反应的异质性。
悉尼大学人类伦理委员会已批准该研究（2023/474）。本研究的结果将发表在同行评议的期刊上，并在国家血管外科学术会议上展示。这些结果将用于提高对抗生素处方决策的理解，并为未来加强指南导向处方的策略提供信息。
