Physician perspectives on de-intensifying diabetes medications.
Ontology highlight
ABSTRACT:
SUBMITTER: Genere N
PROVIDER: S-EPMC5120930 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Background/objectivesGuideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties.DesignNational cross-sectional survey.SettingAmbulatory.ParticipantsRandom sample of geriatricians, general internists, and cardiologists from the American College of Physicians.MeasurementsElectronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases.ResultsIn each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists).ConclusionsWhile barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician-physician and physician-patient communication. J Am Geriatr Soc 68:78-86, 2019.
| S-EPMC7061460 | biostudies-literature
Project description:ObjectiveTo explore primary care provider (PCP) and patient perspectives on postpartum screening for type 2 diabetes (T2DM), including reasons for not completing oral glucose tolerance tests (OGTTs) specifically, preferred provider for organizing screening, and value of reminder letters for facilitating screening.DesignA follow-up survey, administered by fax or telephone, to PCPs and patients who participated in a randomized controlled trial assessing effectiveness of postpartum postal reminders to enhance screening for T2DM in women with gestational diabetes mellitus (GDM).SettingThe Ottawa Hospital, a university-affiliated tertiary centre in Ottawa, Ont.ParticipantsA total of 223 female patients with previously identified GDM and their respective PCPs were surveyed; 173 PCPs and 140 patients participated.Main outcome measuresWhether or not the patient was screened for T2DM post partum, the test used for screening, the factors contributing to the patient not being screened, perspectives on the importance of screening post partum, and opinions about which care provider should be responsible for screening in the postpartum period.ResultsResponse rates were 78% (173 of 223) for PCPs and 63% (140 of 223) for patients. Only 37% of the PCP responders had their patients complete OGTTs, while 85% of patient responders reported that they had completed OGTTs. The most common reason PCPs gave for not screening was no postpartum visit from the patient for any reason. Time pressures were the most common reason provided by patients for not being screened. More than 95% of patients and providers agreed that screening for T2DM was important. Patients and PCPs agreed that PCPs should be responsible for screening. Reminder letters were perceived as helpful by more than 85% of patients and PCPs.ConclusionThis follow-up survey demonstrates that PCPs and patients value the importance of screening for diabetes, identify the PCP as pivotal to screening, and appreciate a reminder strategy. There continue to be barriers that affect screening rates, despite the perceived importance of screening by PCPs and patients.
| S-EPMC2902390 | biostudies-literature
Project description:BackgroundLeadership has been recognized as an important competency in medicine. Nevertheless, leadership curricula for Canadian medical students lacks standardization and may not be informed by medical students' perspectives of physician leadership. The purpose of this study was to elicit these perspectives on physician leadership.MethodsThe present study utilized semi-structured interviews to ascertain the views of medical student participants, including students in their first, second and third years of medical school, on physician leadership. Interview questions were based on 'the 3-C model' of physician leadership, which includes three aspects of leadership, namely character, competence and commitment. The interviews were audio-recorded, transcribed and then coded using thematic analysis.ResultsThe medical students of this study provided rich examples of resident and staff physicians demonstrating effective and ineffective leadership. The participants identified the importance of character to effective physician leadership, but some participants also described a feeling of disconnect with the relevance of character at their stage of training. When discussing physician competence, medical students described the importance of both medical expertise and transferable skills. Lastly, the leadership aspect of commitment was identified as being relevant, but medical students cautioned against the potential for physician burnout. The medical student participants' suggestions for improved leadership development included increased experiences with examples of physician leadership, opportunities to engage in leadership and participation in reflection exercises.ConclusionsOverall, the study participants demonstrated an appreciation for three aspects of leadership; character, competence and commitment. Furthermore, they also provided recommendations for the future design of medical leadership curricula.
| S-EPMC9817360 | biostudies-literature
Project description:PurposeTelemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be used after the COVID-19 public health emergency ends is unclear. Herein, we report on our institution's provider experience after the mature adoption of telemedicine.Methods and materialsWe distributed a survey to all radiation oncology attending physicians at our institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and identify influencing factors whether telemedicine is employed. We calculated the average proportion of visits that providers expected to be appropriately performed with telemedicine for each disease site and visit type.ResultsA total of 60 of the 82 eligible radiation oncologists (73%) responded to the survey, of whom 78% were satisfied with telemedicine in the radiation oncology department and 83% wished to continue offering video visits after the COVID-19 public health emergency ends. Common patient factors influencing whether physicians offer telemedicine include the patient's travel burden, patient preferences, and whether a physical examination is required. Approximately 20% of new consultations and 50% of weekly management visits were estimated to be appropriate for telemedicine. The central nervous system/pediatrics and thoracic faculty considered telemedicine appropriate for the greatest proportion of new consultations, and 93% of respondents felt comfortable determining whether telemedicine was appropriate.ConclusionsSurveyed radiation oncologists were satisfied with telemedicine in their practice, and wished to continue offering video visits in the future. Our data suggest that payers should continue to support this patient-centered technology.
| S-EPMC9598490 | biostudies-literature
Project description:BackgroundPatients undergoing thoracentesis often have comorbid conditions or take medications that potentially put them at higher bleeding risk. Direct oral anticoagulant (DOAC) use has also increased significantly. There are no published guidelines or consensus on when to perform thoracentesis in patients on anticoagulants. Recent studies support the safety of a more liberal approach for thoracentesis among patients with coagulopathy.MethodsWe conducted a survey to ascertain the practices of physicians regarding thoracentesis in patients with increased bleeding risk. The survey was administered to the email distribution lists of the American Association of Bronchology and Interventional Pulmonology and of the American Thoracic Society.ResultsThe survey was completed by 256 attending physicians. Most of them were general pulmonologists practicing at academic medical centers. Most of them would perform a thoracentesis in patients receiving acetylsalicylic acid or prophylactic doses of unfractionated heparin or low molecular weight heparin (96%, 89%, and 88%, respectively). Half of the respondents would perform a thoracentesis in patients on antiplatelet medications (clopidogrel and ticagrelor, 51%; ticlopidine, 53%). A minority would perform thoracentesis in patients on direct oral anticoagulants or infused thrombin inhibitors (19% and 12%, respectively). The only subgroup that had a higher proclivity for performing thoracentesis without holding medications were attending physicians practicing for under 10 years. Relative to noninterventional pulmonologists, there were no significant differences in the responses of interventional pulmonologists.ConclusionThere was variation in the practice patterns of attending physicians in performing thoracentesis in patients with elevated bleeding risk. Further data and guidelines regarding the safety of thoracentesis in these patients are needed.
| S-EPMC6923589 | biostudies-literature
Project description:OBJECTIVE:Expressing therapy benefit from a lifetime perspective, instead of only a 10-year perspective, is both more intuitive and of growing importance in doctor-patient communication. In cardiovascular disease (CVD) prevention, lifetime estimates are increasingly accessible via online decision tools. However, it is unclear what gain in life expectancy is considered meaningful by those who would use the estimates in clinical practice. We therefore quantified lifetime and 10-year benefit thresholds at which physicians and patients perceive statin and antihypertensive therapy as meaningful, and compared the thresholds with clinically attainable benefit. DESIGN:Cross-sectional study. SETTINGS:(1) continuing medical education conference in December 2016 for primary care physicians;(2) information session in April 2017 for patients. PARTICIPANTS:400 primary care physicians and 523 patients in the Netherlands. OUTCOME:Months gain of CVD-free life expectancy at which lifelong statin therapy is perceived as meaningful, and months gain at which 10 years of statin and antihypertensive therapy is perceived as meaningful. Physicians were framed as users for lifelong and prescribers for 10-year therapy. RESULTS:Meaningful benefit was reported as median (IQR). Meaningful lifetime statin benefit was 24 months (IQR 23-36) in physicians (as users) and 42 months (IQR 12-42) in patients willing to consider therapy. Meaningful 10-year statin benefit was 12 months (IQR 10-12) for prescribing (physicians) and 14 months (IQR 10-14) for using (patients). Meaningful 10-year antihypertensive benefit was 12 months (IQR 8-12) for prescribing (physicians) and 14 months (IQR 10-14) for using (patients). Women desired greater benefit than men. Age, CVD status and co-medication had minimal effects on outcomes. CONCLUSION:Both physicians and patients report a large variation in meaningful longevity benefit. Desired benefit differs between physicians and patients and exceeds what is clinically attainable. Clinicians should recognise these discrepancies when prescribing therapy and implement individualised medicine and shared decision-making. Decision tools could provide information on realistic therapy benefit.
| S-EPMC5988148 | biostudies-literature
Project description:BackgroundCollaboration between people with type 2 diabetes (T2DM) and their health care teams is important for optimal control of the disease and outcomes. Digital technologies could potentially tie together several health care-related devices and platforms into connected ecosystems (CES), but attitudes about CES are unknown.ObjectiveWe surveyed convenience samples of patients and physicians to better understand which patient characteristics are associated with higher likelihoods of (1) participating in a potential CES program, as self-reported by patients with T2DM and (2) clinical benefit from participation in a potential CES program, as reported by physicians.MethodsAdults self-reporting a diagnosis of T2DM and current insulin use (n=197), and 33 physicians whose practices included ≥20% of such patients, were enrolled in the United States, France, and Germany. We surveyed both groups about the likelihood of patient participation in a CES. We then examined the associations between patients' clinical and sociodemographic characteristics and this likelihood. We also described characteristics of patients likely to clinically benefit from CES use, according to physicians.ResultsCompared with patients in Germany and France, US patients were younger (mean age 45.3 [SD 11.9] years vs 61.9 [SD 9.2] and 65.8 [SD 9.4] years, respectively), more often female, more highly educated, and more often working full-time. In all, 51 (44.7%) US patients, 16 (36.4%) German patients, and 18 (46.3%) French patients indicated strong interest in a CES program, and 115 (78.7%) reported currently using ≥1 connected device or app. However, physicians believed that only 11.3%-19.2% of their patients were using connected devices or apps to manage their disease. Physicians also reported infrequently recommending or prescribing connected devices to their patients, although ≥80% (n=28) of them thought that a CES could help support their patients in managing their disease. The factors most predictive of patient likelihood of participating in a CES program were cost, inclusion of medication reminders, and linking blood glucose levels to behaviors such as eating and exercise. In all countries, the most common patient expectations for a CES program were that it could help them eat more healthfully, increase their physical activity, increase their understanding of how blood glucose relates to behavior such as exercise and eating, and reduce stress. Physicians thought that newly diagnosed patients, sicker patients-those who had been hospitalized for diabetes, were currently using insulin, or who had any comorbid condition-and patients who were nonadherent to treatment were most likely to benefit from CES use.ConclusionsIn this study, there was a high degree of interest in the future use of CES, although additional education is needed among both patients with T2DM and their physicians to achieve the full potential of such systems to improve self-management and clinical care for the disease.
| S-EPMC10722356 | biostudies-literature
Project description:ObjectivesThe concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient-reported and physician-rated CRS disease control.Study typeCross-sectional.MethodsA total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as "not at all," "a little," "somewhat," "very," and "completely." All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and also reported the number of sinus infections, CRS-related antibiotic courses taken, CRS-related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund-Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT-22 score (as well as SNOT-22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS-related antibiotics, CRS-related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as "not at all," "a little," "somewhat," "very," and "completely." Associations were sought between CRS disease characteristics (SNOT-22 score, endoscopy score, sinus infections, CRS-related antibiotic usage, CRS-related oral corticosteroid usage, and lost productivity due to CRS) and patient-reported CRS control as well as mean physician-rated CRS control.ResultsPatient-reported global CRS control was associated only with SNOT-22 (adjusted relative risk [RR]?=?0.99, 95% CI: 0.98-0.99, P?<?.001) but no other CRS disease characteristic. Patient-reported CRS control was specifically associated only with nasal symptoms and not extra-nasal symptoms of CRS. Physician-rated CRS control was associated with SNOT-22 score (adjusted RR [for each 1-unit increase of SNOT-22]?=?0.99, 95% CI: 0.98-0.99, P?<?.001), number of acute bacterial CRS exacerbations-reflected by number of antibiotic courses taken (or sinus infections)-in the last 3 months (adjusted RR?=?0.89, 95% CI: 0.82-0.98, P?=?.014) and the number of CRS-related oral corticosteroid courses taken in the last 3 months (adjusted RR?=?0.87, 95% CI: 0.78-0.97, P?=?.012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician-rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting poorly controlled CRS.ConclusionsPatients and physicians use different criteria to determine the level of CRS control. While both rely on the burden of CRS symptomatology, patients consider primarily nasal symptoms while physicians include nasal and extra-nasal symptoms of CRS in determining CRS control. Physicians also independently consider CRS-related antibiotic use, as a reflection of acute bacterial CRS exacerbations, and CRS-related oral corticosteroid use in the determination of global CRS control.Level of evidence2c.
| S-EPMC6302712 | biostudies-literature
Project description:PurposeDiscontinuation of statin therapy represents a major challenge for effective cardiovascular disease prevention. It is unclear how often primary care physicians (PCPs) re-initiate statins and what barriers they encounter. We aimed to identify PCP perspectives on factors influencing statin re-initiation.MethodsWe conducted six nominal group discussions with 23 PCPs from the Deep South Continuing Medical Education network. PCPs answered questions about statin side effects, reasons their patients reported for discontinuing statins, how they respond when discontinuation is reported, and barriers they encounter in getting their patients to re-initiate statin therapy. Each group generated a list of responses in round-robin fashion. Then, each PCP independently ranked their top three responses to each question. For each PCP, the most important reason was given a weight of 3 votes, and the second and third most important reasons were given weights of 2 and 1, respectively. We categorized the individual responses into themes and determined the relative importance of each theme using a "percent of available votes" metric.ResultsPCPs reported that side effects, especially muscle/joint-related symptoms, were the most common reason patients reported for statin discontinuation (47% of available votes). PCPs reported statin re-challenge as their most common response when a patient discontinues statin use (31% of available votes). Patients' fear of side effects was ranked as the biggest challenge PCPs encounter in getting their patients to re-initiate statin therapy (70% of available votes).ConclusionPCPs face challenges getting their patients to re-initiate statins, particularly after a patient reports side effects.
| S-EPMC6939993 | biostudies-literature
Project description:Physician perception of medication adherence may alter prescribing patterns. Perception of patients has been linked to readily observable factors, such as race and age. Obesity shares a similar stigma to these factors in society. We hypothesized that physicians would perceive patients with a higher BMI as nonadherent to medication. Data were collected from the baseline visit of a randomized clinical trial of patient-physician communication (240 patients and 40 physicians). Physician perception of patient medication adherence was measured on a Likert scale and dichotomized as fully adherent or not fully adherent. BMI was the predictor of interest. We performed Poisson regression analyses with robust variance estimates, adjusting for clustering of patients within physicians, to examine the association between BMI and physician perception of medication adherence. The mean (s.d.) BMI was 32.6 (7.7) kg/m(2). Forty-five percent of patients were perceived as nonadherent to medications by their physicians. Higher BMI was significantly and negatively associated with being perceived as adherent to medication (prevalence ratio (PrR) 0.76, 95% confidence interval (CI): 0.64-0.90; P = 0.002; per 10 kg/m(2) increase in BMI). BMI remained significantly and negatively associated with physician perception of medication adherence after adjustment for patient and physician characteristics (PrR 0.80, 95% CI: 0.66-0.96; P = 0.020). In this study, patients with higher BMI were less likely to be perceived as adherent to medications by their providers. Physician perception of medication adherence has been shown to affect prescribing patterns in other studies. More work is needed to understand how this perception may affect the care of patients with obesity.
| S-EPMC3149807 | biostudies-other