Dataset Information

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

ABSTRACT:

Background

Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making.

Methods

Cross-sectional, semi-structured questionnaire-based study.

Results

Of the 726 respondents (response rate = 66%), the majority chose second-generation antipsychotics (SGAs) if they had to prescribe it for themselves (n = 530, 93%) or for their patients (n = 546, 94%). The main factor influencing choice was perceived efficacy, 84.8% (n = 475) of trainees stating this was the most important factor for the patient, and 77.8% (n = 404) stating this was the most important factor for their own treatment. Trainees with knowledge of trials questioning use of SGAs (CATIE, CUtLASS, TEOSS) were more likely to choose second-generation antipsychotics than those without knowledge of these trials (?2 = 3.943; p = 0.047; O.R. = 2.11; 95% C.I. = 1.0-4.48). Regarding psychotherapy, cognitive behavioural therapy (CBT) was the most popular choice for self (33.1%; n = 240) and patient (30.9%; n = 224). Trainees were significantly more likely to prefer some form of psychotherapy for themselves rather than patients (?2 = 9.98; p < 0,002; O.R. = 1.54; 95% CIs = 1.18-2.0).

Conclusions

Trainees are more likely to choose second-generation antipsychotic medication for patients and themselves. Despite being aware of evidence that suggests otherwise, they predominantly base these choices on perceived efficacy.

SUBMITTER: Jauhar S

PROVIDER: S-EPMC3337226 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

Jauhar Sameer S Guloksuz Sinan S Andlauer Olivier O Lydall Greg G Marques João Gama JG Mendonca Luis L Dumitrescu Iolanda I Roventa Costin C De Vriendt Nele N Van Zanten Jeroen J Riese Florian F Nwachukwu Izu I Nawka Alexander A Psaras Raphael R Masson Neil N Krishnadas Rajeev R Volpe Umberto U

BMC psychiatry 20120330

<h4>Background</h4>Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making.<h4>Methods</h4>Cross-sectional, semi-structured questionnaire-based study.<h4>Results</h4>Of the 726 respondents (response rate = 66%), the majority c ...[more]

PMID: 22463055

Similar Datasets

Project description:BackgroundAn Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis.MethodsWe examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems.ResultsWe found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39-1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49-0.76) and ischaemic stroke (HR = 0.27, CI 0.08-0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results.ConclusionWe performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on 'patients like me'. We identify the key challenges in offering such an Informatics Consult as a service.

Dataset Information

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

Background

Methods

Results

Conclusions

Publications

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets