The myth of agency and patient choice in health care? The case of drug treatments to prevent coronary disease

Bryan, Stirling; Gill, Paramjit; Greenfield, Sheila; Gutridge, Kerry; Marshall, Tom

doi:10.1016/j.socscimed.2006.07.008

Cited by 21 publications

(16 citation statements)

References 11 publications

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“…We have no information on patients' treatment preferences, which are not predictable from patients' age, sex or risk factor status and may not accord with guideline recommendations [43], [44]. However there is little evidence that general practitioners take account of patients' preferences when starting preventive treatments [45].…”

Section: Discussionmentioning

confidence: 99%

Patient Factors Influencing the Prescribing of Lipid Lowering Drugs for Primary Prevention of Cardiovascular Disease in UK General Practice: A National Retrospective Cohort Study

Zhu

Yao

et al. 2013

PLoS ONE

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BackgroundGuidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions.MethodsA retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008) patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing.ResultsOf 365,718 patients with complete data, 13.8% (50,558) were prescribed lipid lowering drugs: 28.5% (21,101/74,137) of those eligible and 10.1% (29,457/291,581) of those ineligible. Only 41.7% (21,101/50,558) of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥65 years 4.21; 95% CI 4.05–4.39); diabetes (OR 4.49; 95% CI 4.35–4.64); total cholesterol level ≥7 mmol/L (OR 2.20; 95% CI 2.12–2.29); and ≥4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06–4.42). The predictors were similar in eligible and ineligible patients.ConclusionsMost lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.

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Section: Discussionmentioning

confidence: 99%

Patient Factors Influencing the Prescribing of Lipid Lowering Drugs for Primary Prevention of Cardiovascular Disease in UK General Practice: A National Retrospective Cohort Study

Zhu

Yao

et al. 2013

PLoS ONE

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“…The shared decision-making model brings us out of the canonical paradigm of agency relations without falling into the model where the patient is the only decider and the (benevolent) doctor is a simple technical adviser (Gafni et al 1998). This conception of the doctor-patient interaction appears to be more in line with the diagnoses and therapies actually observed in health centres (Bryan et al 2006;Moumjid et al 2003).…”

Section: Empowerment Of the Patient And Market Powermentioning

confidence: 99%

Market Empowerment of the Patient: The French Experience

Batifoulier

Domin

Gadreau

2011

Review of Social Economy

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Through analysis of the French experience, this article explores the way economic policy has sought to encourage active, well-informed patients by giving them market power. The new status of the patient as consumer is based on two foundations: the endeavour to build a healthcare market and the activation of demand-based policies. The keystone of this new system is a conception of the market as a process constructed by economic policy. Recent measures such as the standardization of care and the introduction of incentives to respect a treatment pathway then constitute effective levers to establish a free-market rationale.

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“…[48][49][50][51] Choice How much choice is the patient given from their physician, provider and payer? [48,55,56] Shared decision making How is the patient involved in medical decision making? How does the physician influence other decisions of the patient?…”

Section: Antecedents To Empowermentmentioning

confidence: 99%

“…The usual framework for 'informed choice' is that patients have the relevant information regarding the advantages and disadvantages of all the possible treatment courses in accordance with their own beliefs [48]. This is in contrast to the paternalism of central Europe [2], the centralized decision making of the UK [56] and Canada, and even the managed care movement in the USA that aims to constrain the availability of patient choice.…”

Section: Choicementioning

confidence: 99%

Promoting patient empowerment in the healthcare system: highlighting the need for patient-centered drug policy

Loukanova¹,

Molnar²,

Bridges³

2007

Expert Review of Pharmacoeconomics & Outcomes Research

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In recent years the term 'patient empowerment' has increasingly been used among healthcare policy makers; however, discussions have focused on narrow activities that as stand-alone activities would be unlikely to give patients power. This paper presents findings from a systematic review of the medical literature. After offering a new definition of patient empowerment, we review the literature behind the concept, aided by a conceptual model. The model is derived from our review of all papers published in medicine (Medline) between 1980 and 2005, and is focused around issues related to the antecedents, activities and outcomes of patient empowerment, especially as they relate to researchers who may need to formulate or evaluate public policies aimed at the issue. We strive to stimulate more discussion of the linkages between public policy and patient empowerment, identifying a need to take a holistic approach, especially when policies are aimed at empowering patients in the area of personal drug management.

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The myth of agency and patient choice in health care? The case of drug treatments to prevent coronary disease

Cited by 21 publications

References 11 publications

Patient Factors Influencing the Prescribing of Lipid Lowering Drugs for Primary Prevention of Cardiovascular Disease in UK General Practice: A National Retrospective Cohort Study

Patient Factors Influencing the Prescribing of Lipid Lowering Drugs for Primary Prevention of Cardiovascular Disease in UK General Practice: A National Retrospective Cohort Study

Market Empowerment of the Patient: The French Experience

Promoting patient empowerment in the healthcare system: highlighting the need for patient-centered drug policy

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