The Evolution of Clinical Policies

Dixon, A. St. J.

doi:10.1097/00005650-199003000-00002

Cited by 49 publications

(24 citation statements)

References 43 publications

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“…As with many other medical treatments, the use of HRT has posed a dissemination model that adjusts perfectly to Dixon's postulate [37]. Experts' recommendations are often not based on scientific evidence, and this leads to an inappropriate use of treatments, based on doctors' trust in the consensus of specialists and experts.…”

Section: Discussionmentioning

confidence: 99%

Physicians and the prescription of hormone replacement therapy in Spain

Bermejo

Ruiz-Pérez

2005

Health Policy

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Section: Discussionmentioning

confidence: 99%

Physicians and the prescription of hormone replacement therapy in Spain

Bermejo

Ruiz-Pérez

2005

Health Policy

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“…Other important determinants of physicians’ management of back pain include patients’ presentation of symptoms, knowledge and beliefs; expectations about the consultation; patient satisfaction; provision of reassurance; relationship to work; and maintenance of the doctor–patient relationship 15 , 16 . Societal factors, such as prevailing community views and existing legislation regarding sickness absence and compensation, can also affect medical behaviour and decisions 17 …”

Section: Rationale For a Population Approach To Addressing Back Pain mentioning

confidence: 99%

Self‐management education en masse: effectiveness of the Back Pain: Don’t Take It Lying Down mass media campaign

Buchbinder

2008

Medical Journal of Australia

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Despite the availability of a range of Australian self‐management support programs targeting the individual patient and/or health professional, three‐quarters of Australians have at least one long‐term medical condition, suggesting that a more comprehensive public health approach is needed. Use of mass media to deliver community health messages is a well established public health strategy. It may enhance more targeted approaches with its ability to reach large numbers of people simultaneously, including those difficult to identify, high‐risk groups and those difficult to reach through traditional medical delivery. By simultaneously influencing large numbers of people, well designed health messages have the potential to promote and maintain behavioural change over time. Back Pain: Don’t Take It Lying Down (1997–1999), a mass media campaign of the Victorian WorkCover Authority, can be seen as a prototype of a successful public health strategy designed to enhance people's self‐management abilities. One of the main messages of the campaign was that there is a lot you can do to help yourself, which emphasises shifting the responsibility of control onto the individual. The success of the campaign makes a compelling evidence‐based case for using a similar strategy to enhance the self‐management abilities of the population.

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“… 14,17–23 A second assumption is that rapid adoption of new advances is an unqualified good. 4,13–16,24,25 The history of medicine, however, is punctuated with examples of innovations that were rapidly adopted and later found to be ineffective or harmful. 16,24,25 Specialists may adopt emerging therapies more aggressively, independent of the available evidence, while generalists may deliberately delay adoption until there is more evidence of benefit or the long‐term risks are better understood.…”

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confidence: 99%

Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction

et al. 2001

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OBJECTIVE: Recent reports have linked calcium channel blockers (CCBs) with an increased risk of acute myocardial infarction (AMI). We sought to determine to what extent physicians relinquished CCBs following these adverse reports and if there were differences in the use of CCBs and other AMI therapies across 3 levels of specialist involvement: generalist attendings, collaborative care (generalist with cardiologist consultation), and cardiologist attendings. DESIGN:We measured use of CCBs during hospitalization for AMI before (1992±1993) and after (1995±1996) the adverse CCB reports, controlling for hospital-, physician-, and patient-level variables. We also examined use of effective medications (aspirin, b b-blockers, thrombolytic therapy) and ineffective AMI treatments (lidocaine).SETTING: Thirty-seven community-based hospitals in Minnesota.PATIENTS: Population-based sample of 5,347 patients admitted with AMI. MEASUREMENTS:The primary outcome was prescription of a CCB at the time of discharge from hospital. Secondary outcomes included use of other effective and ineffective AMI therapies during hospitalization and at discharge. . From 1992±1993 to 1995±1996, the use of CCBs in patients with AMI decreased from 24% to 10%, the net result of physicians starting CCBs less often and discontinuing them more often. In multivariate models, the odds of CCB relinquishment after the adverse reports (adjusted OR, 0.33; 95% CI, 0.27 to 0.39) were independent of, and not modified by, the involvement of a cardiologist. CONCLUSIONS:Compared with cardiologists, generalist physicians were less likely to adopt some effective AMI therapies, particularly those associated with risk such as thrombolytic therapy. However, generalists were as likely as cardiologists to relinquish CCBs after the adverse reports. This pattern of practice may be the generalist physicians' response to an expanding, but increasingly risky and uncertain, pharmacopoeia.

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The Evolution of Clinical Policies

Cited by 49 publications

References 43 publications

Physicians and the prescription of hormone replacement therapy in Spain

Physicians and the prescription of hormone replacement therapy in Spain

Self‐management education en masse: effectiveness of the Back Pain: Don’t Take It Lying Down mass media campaign

Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction

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