Written case simulations: Do they predict physicians' behavior?

Jones, Thomas V.; Gerrity, Martha S.; Earp, JoAnne

doi:10.1016/0895-4356(90)90241-g

Cited by 209 publications

(141 citation statements)

References 68 publications

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“…In a review of 74 published studies using written case simulations, the validity issue was addressed in only 14 and conclusions were con icting (18). Kuyvenhove n et al (19) conclude that case simulations give a realistic impression of GPs' diagnostic and therapeutic approaches to patients with vague symptoms.…”

Section: Resultsmentioning

confidence: 99%

Perception of risk information. Similarities and differences between Danish and Polish general practitioners

Nexøe

Ołtarzewska

Sawicka-Powierza

et al. 2002

Scandinavian Journal of Primary Health Care

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Section: Resultsmentioning

confidence: 99%

Perception of risk information. Similarities and differences between Danish and Polish general practitioners

Nexøe

Ołtarzewska

Sawicka-Powierza

et al. 2002

Scandinavian Journal of Primary Health Care

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“…Previous research has documented variability in the extent to which written case simulations reflect actual clinical practice. 17,18 Response and social desirability biases may have inflated rates of compliance with guidelines and underestimated use of nonpreferred drugs. This is the first study to our knowledge that addresses when and why physicians use drug samples, and under what circumstances physicians will subsequently prescribe a medication that was initially dispensed as a drug sample.…”

Section: Discussionmentioning

confidence: 99%

A physician survey of the effect of drug sample availability on physicians’ behavior

et al. 2000

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OBJECTIVE: Pharmaceutical companies often use drug samples as a marketing strategy in the ambulatory care setting. Little is known about how the availability of drug samples affects physicians' prescribing practices. Our goal was to assess: (1) under what circumstances and why physicians dispense drug samples, (2) if drug samples lead physicians to use medications other than their preferred drug choice, and (3) the physician characteristics that are associated with drug sample use. DESIGN:Cross-sectional survey. SETTING:University-based clinics at one academic medical center.PARTICIPANTS: 154 general medicine and family physicians. MEASUREMENTS AND MAIN RESULTS:Physicians' selfreported prescribing patterns for 3 clinical scenarios, including their preferred drug choice, whether they would use a drug sample and subsequently prescribe the sampled medication, and the importance of factors involved in the decision to dispense a drug sample. A total of 131 (85%) of 154 physicians responded. When presented with an insured woman with an uncomplicated lower urinary tract infection, 22 (17%) respondents reported that they would dispense a drug sample; 21 (95%) of 22 sample users stated that they would dispense a drug sample that differed from their preferred drug choice. For an uninsured man with hypertension, 35 (27%) respondents reported that they would dispense a drug sample; 32 (91%) of 35 sample users indicated that they would dispense a drug sample instead of their preferred drug choice. For an uninsured woman with depression, 108 (82%) respondents reported that they would dispense a drug sample; 53 (49%) of 108 sample users indicated that they would dispense a drug sample that differed from their preferred drug choice. Avoiding cost to the patient was the most consistent motivator for dispensing a drug sample for all 3 scenarios. For 2 scenarios, residents were more likely to report using drug samples than attendings ( P Ͻ .05). When respondents who chose a drug sample for 2 or 3 scenarios were compared to those who never chose to use a drug sample, or chose a drug sample for only one scenario, only younger age was independently associated with drug sample use. CONCLUSION:In self-reports, the availability of drug samples led physicians to dispense and subsequently prescribe drugs that differ from their preferred drug choice. Physicians most often report using drug samples to avoid cost to the patient.

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“…The major limitation is that it is a simulation-based survey that does not examine actual physician behavior. 22 We measured knowledge and attitudes about medication use. However, given this hypothetical "test" situation in which the social desirability bias would be to increase the number of "correct" answers, we are probably overestimating the use of ACE inhibitors compared with actual clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

et al. 1997

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OBJECTIVE:To quantify the extent and determinants of underutilization of angiotensin-converting enzyme (ACE) inhibitors for patients with congestive heart failure, especially with respect to physician specialty and clinical indication. DESIGN:Survey of a national systematic sample of physicians. PARTICIPANTS:Five hundred family practitioners, 500 general internists, and 500 cardiologists. MEASUREMENTS AND MAIN RESULTS:Physicians' choice of medications were determined for four hypothetical patients with left ventricular systolic dysfunction: (1) new-onset, symptomatic; (2) asymptomatic; (3) chronic heart failure, on digitalis and diuretic; and (4) asymptomatic, post-myocardial infarction. For each patient, randomized controlled trials have demonstrated that ACE inhibitors decrease mortality or the progression of symptoms. Among the 727 eligible physicians returning surveys (adjusted response rate 58%), approximately 90% used ACE inhibitors for patients with chronic heart failure who were already taking digitalis and a diuretic. However, family practitioners and general internists chose ACE inhibitors less frequently ( p Յ .01) than cardiologists for the other indications. Respective rates of ACE inhibitor use for each simulated patient were new-onset, symptomatic (family practitioners 72%, general internists 76%, cardiologists 86%); asymptomatic (family practitioners 68%, general internists 78%, cardiologists 93%); and asymptomatic, postmyocardial infarction (family practitioners 58%, general internists 70%, cardiologists 94%). Compared with generalists, cardiologists were more likely ( p Յ .05) to increase ACE inhibitors to a target dosage (45% vs 26%) and to tolerate systolic blood pressures of 90 mm Hg or less (43% vs 15%). he appropriate role of generalist and specialist physicians in the care of patients is controversial. 1 It is generally assumed that the sickest, most complicated patients, as well as patients with rare disorders, benefit most from specialty care. However, the majority of patients with chronic diseases such as heart failure, diabetes, or chronic obstructive pulmonary disease initially are not severely ill, and are therefore first seen by the generalist physician. The most cost-effective threshold for specialty referral and the optimal mix of generalist and specialist care remain unknown. 2 Congestive heart failure is an ideal model to study variation in physicians' practice patterns among patients with chronic disease. This syndrome is common and presently the domain of both generalist and specialist physicians. Advances in cardiac transplantation and hemodynamically titrated therapy have made some of the sickest patients clear candidates for referral to cardiologists. 3 Recently, however, multicenter trials of angiotensin-converting enzyme (ACE) inhibitors have modified the standard of treatment for a broad range of patients with heart failure. 4 These medications have been found to decrease mortality in patients with chronic heart failure and ejection fractions of 0.35 or less, 5 decrease...

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Written case simulations: Do they predict physicians' behavior?

Cited by 209 publications

References 68 publications

Perception of risk information. Similarities and differences between Danish and Polish general practitioners

Perception of risk information. Similarities and differences between Danish and Polish general practitioners

A physician survey of the effect of drug sample availability on physicians’ behavior

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

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