Beyth R J, Antani M R, Covinsky K E, Miller D G, Chren M M, Quinn L M, Landefeld C S
Division of General Internal Medicine, Cleveland Veterans Affairs Medical Center, OH 44106, USA.
J Gen Intern Med. 1996 Dec;11(12):721-8. doi: 10.1007/BF02598985.
To determine the opinions of selected physicians in our community about use of warfarin for patients with nonrheumatic atrial fibrillation, and to determine the relation of the physicians' opinions to their practices.
Survey of physicians, using eight hypothetical clinical vignettes to characterize physicians' opinions about use of warfarin in patients with nonrheumatic atrial fibrillation, according to patient age, risk of bleeding, and risk of stroke.
Two teaching hospitals and five community-based practices.
Eighty physicians who cared for 189 consecutive patients with nonrheumatic atrial fibrillation.
The survey response rate was 73%. Nearly all responding physicians (90%) recommended warfarin for at least one vignette. However, physicians recommended warfarin less often for vignettes depicting 85-year-old patients than for matched vignettes depicting 65-year-old patients (odds ratio [OR] 0.03; 95% confidence interval [CI] 0.01, 0.08), and less often for cases with specified risk factors for bleeding than for matched cases without the risk factors (OR 0.01; 95% CI 0.004, 0.03); warfarin was recommended more often for cases with a recent stroke than for matched cases without this history (OR 8.2; 95% CI 3.6, 18). In practice, warfarin was prescribed more often (p < or = .05) by physicians reporting good personal experience and by those who had favorable opinions about its use. However, even physicians with good experience and favorable opinions did not prescribe warfarin to half of their patents for whom warfarin was independently judged appropriate.
Physicians' opinions frequently opposed warfarin for older patients with nonrheumatic atrial fibrillation, and for those with bleeding risk factors. Physicians' opinions, as well as other barriers to warfarin therapy, most likely contribute to its infrequent prescription.
确定本社区部分医生对于非风湿性心房颤动患者使用华法林的看法，并确定医生的看法与其实际做法之间的关系。
对医生进行调查，使用八个假设的临床案例来描述医生根据患者年龄、出血风险和中风风险对非风湿性心房颤动患者使用华法林的看法。
两家教学医院和五个社区诊所。
80名医生，他们连续照料了189名非风湿性心房颤动患者。
调查回复率为73%。几乎所有回复的医生（90%）至少对一个案例推荐了华法林。然而，对于描述85岁患者的案例，医生推荐使用华法林的频率低于描述65岁患者的匹配案例（优势比[OR]0.03；95%置信区间[CI]0.01，0.08），对于有特定出血风险因素的案例，推荐频率低于没有风险因素的匹配案例（OR 0.01；95%CI 0.004，0.03）；对于近期有中风史的案例，推荐华法林的频率高于没有此病史的匹配案例（OR 8.2；95%CI 3.6，18）。在实际操作中，报告有良好个人经验的医生以及对其使用持赞成意见的医生更常开具华法林（p≤0.05）。然而，即使是有良好经验且持赞成意见的医生，对于那些经独立判断适合使用华法林的患者，也有一半未给他们开具华法林。
医生的看法常常反对给患有非风湿性心房颤动的老年患者以及有出血风险因素的患者使用华法林。医生的看法以及华法林治疗的其他障碍很可能导致其处方开具不频繁。
