Applying research evidence to individuals in primary care: a study using non-rheumatic atrial fibrillation

Oswald, Nigel; Bateman, Hilarie

doi:10.1093/fampra/16.4.414

Cited by 17 publications

(14 citation statements)

References 12 publications

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“…Editor-Kalra et al's paper looking at the efficacy of anticoagulation for stroke prevention in atrial fibrillation 1 essentially complements Copland et al's work in showing that an elderly population can be given adequate anticoagulation. 2 As Kalra et al performed a cohort study with no control population, the study does not allow any estimate of the effectiveness of the treatment as is suggested in the paper. Thus we do not know if there was any treatment benefit.…”

Section: It's Still Not Clear Whether Results In Secondary Care Transmentioning

confidence: 99%

“…1 Connolly's editorial says that meta-analysis of trials shows that the risk of ischaemic stroke is reduced by two thirds and asks why warfarin is underused. 2 In Kalra et al's study six ischaemic strokes occurred. Assuming a risk reduction of two thirds then around 12 were prevented.…”

Section: General Practitioners Have To Decide Best Ways Of Allocatingmentioning

confidence: 95%

“…1 Pooled data from randomised controlled studies in patients with atrial fibrillation showed that anticoagulation reduced ischaemic stroke by two thirds. 2 Despite such a dramatic benefit, warfarin is underused in patients with atrial fibrillation in clinical practice, 3 particularly in elderly rural patients. 4 I wished to see why warfarin was not prescribed to patients with atrial fibrillation with risk factors for stroke in a clinical setting.…”

Section: Rapid Anticoagulant Testing Is Not Available In General Pracmentioning

confidence: 99%

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Decline in teenage smoking with rise in mobile phone ownership: hypothesis

Charlton

2000

BMJ

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Editor-The good news is that the seemingly inexorable rise in teenage smoking in Britain has reversed. A sharp decline in the late 1990s has been as fast as the rise in the early 1990s. The table shows changes since the peak in 1996. 1 We hypothesise that the fall in youth smoking and the rise in ownership of mobile phones among adolescents are related. The functions that smoking offers to teenagers have been extensively studied, 2 and we argue that the mobile phone is an effective competitor to cigarettes in the market for products that offer teenagers adult style, individuality, sociability, rebellion, peer group bonding, and adult aspiration. The marketing of mobile phones is rooted in promoting self image and identity, which resembles cigarette advertising. As ownership increases, mobile phones will become essential for membership of peer groups that organise their social life on the move and by means of mobile phones. Over the period in which smoking rates have fallen among 15 year olds the ownership of mobile phones has sharply increased, having risen from low rates in the early 1990s (figure). The trend in ownership of mobile phones has continued sharply upwards, with ownership reaching 73% among 15-24 year olds and 70% among 15-17 year olds by August 2000. To explain the link with declining teenage smoking, mobile phones are particularly important as they consume teenagers' available cash, especially the pay as you go cards. If some teenagers cannot afford to smoke and pay for a mobile phone or they find that owning a mobile phone satisfies the same needs as smoking, they may decide not to smoke. Smoking may become seen as old technology, with the bright new world of text messaging, email, WAP, and 3G phones becoming the new aspirational gateway to adult life. Given the continued rise in ownership of mobile phones, will the trend continue? Data on teenage smoking are not yet available for 2000, but if our hypothesis is correct the need to own a mobile phone will be providing vigorous competition for the spare cash once spent on cigarettes, while meeting many of same the needs.

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Section: It's Still Not Clear Whether Results In Secondary Care Transmentioning

confidence: 99%

Section: General Practitioners Have To Decide Best Ways Of Allocatingmentioning

confidence: 95%

Section: Rapid Anticoagulant Testing Is Not Available In General Pracmentioning

confidence: 99%

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Decline in teenage smoking with rise in mobile phone ownership: hypothesis

Charlton

2000

BMJ

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“…The Scientific Board of the Royal College of General Practitioners provided funding for the original study. Aspects of this study were first published in Family Practice ( Oswald & Bateman 1999). Tables 1 and 2 are taken from that paper, and we are very grateful to the Editor for permission to include material from the original publication.…”

Section: Acknowledgementsmentioning

confidence: 99%

Treating individuals according to evidence: why do primary care practitioners do what they do?

Oswald¹,

Bateman²

2000

Evaluation Clinical Practice

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Research evidence does not necessarily translate into changed management for individual patients, but that may not mean that the evidence has been ignored. Drawing on accounts from general practitioners, we use a study of non-rheumatic atrial fibrillation (NRAF) to illuminate the processes by which practitioners became aware of and assimilated research evidence. We follow that with an account of how the evidence was incorporated into practice protocols for anticoagulation and then applied to a review of individual patients' records. Practitioners used a range of sources of evidence. They reported difficulties arising from their own skills and circumstances and from the perceived quality of the evidence. Creating a protocol involved overcoming problems of scheduling, resources and managing judgements about the value of the review process. In applying the protocol practitioners drew on their knowledge of the patients' preferences, circumstances and previous specialist consultations. As a result, practitioners made judgements that evidence, combined with prior experience, did not support the initiation of anticoagulation in 52% of an unselected primary care population with NRAF. Our findings have implications for evidence-based practice and for practitioner education.

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“…23 GPs in the UK tend to overestimate both the number of their patients who meet eligibility thresholds for anticoagulant therapy and also the number of their patients currently receiving warfarin. 13,24 At the same time, attempts to change prescribing practices, for example the introduction of quality indicators, 25 education including knowledge and skills training, 26 computerised feedback 27 (although this has been criticised as consultation outcomes often need to vary from the decision support software's recommendations 28 ), risk reduction strategies such as patient-specific information aids to help prescriber decision-making i.e. Mini Mental State Examination (MMSE) to help with cognition rating 29 and shared decision-making, 30 paced information with the opportunity to check understanding at a later time, 29 and the introduction of practice-specific protocols 13 all show some success, although they are often limited to the specific setting, with little sustainability or generalisability.…”

Section: Literature Overviewmentioning

confidence: 99%

What are the differences between physician and patient expectation with regard to the management of atrial fibrillation?

Mr¹,

Montana²

2012

J R Coll Physicians Edinb

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Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with approximately 840,000 people suffering from it nationally. People with AF have an increased risk of stroke which can be mitigated effectively with the use of anticoagulant therapy. Nevertheless, evidence suggests that less than 50% of eligible patients are receiving this form of intervention. Method: A comprehensive literature search was undertaken to assess the published evidence in order to understand why clinicians and patients underutilize an effective intervention such as anticoagulation in favor of the less effective antiplatelet agents. Results: The decision to use anticoagulant drugs in patients with AF involves a consideration of the potential benefits versus the risks, inconveniences, and costs. There is however widespread variation in the importance placed on these factors across primary care practices, individual doctors and between and within different patient groups. There is a paucity of literature designed to examine patient expectations. Available studies suggest that patients are prepared to be placed at a higher risk of bleeding than their prescribing doctors would be prepared to accept. Given that this judgement depends on a range of factors, it is not surprising that attempts to understand clinician's barriers to prescribing take precedence. Conclusion: The barriers to anticoagulation can be identified, but we still don't understand the importance that clinicians and individuals give them. These barriers continue to limit the use of anticoagulation therapy, a potentially beneficial treatment. Due to these limitations it is unclear what impact the increased range of oral anticoagulants and the alternation to the Quality and Outcomes Framework (QoF) will have on the incentive to primary care physicians to anticoagulate those at risk.

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Applying research evidence to individuals in primary care: a study using non-rheumatic atrial fibrillation

Cited by 17 publications

References 12 publications

Decline in teenage smoking with rise in mobile phone ownership: hypothesis

Decline in teenage smoking with rise in mobile phone ownership: hypothesis

Treating individuals according to evidence: why do primary care practitioners do what they do?

What are the differences between physician and patient expectation with regard to the management of atrial fibrillation?

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