Physicians’ Knowledge and Attitudes about Coronary Heart Disease Prevention Guidelines and Technology Assisted Interventions

Abstract

BJC Healthcare is conducting a randomized controlled study to evaluate the impact of a technology-assisted pharmacist intervention on physicians’ adherence to national coronary heart disease (CHD) prevention guidelines. We surveyed physicians to assess their knowledge of the guidelines and attitudes toward pharmacist-mediated interventions.

Introduction

Clinical reminders and academic detailing are effective methods for translating guidelines into practice.¹ Automated guideline monitor (AGM) was developed to improve adherence to established guidelines for secondary-prevention medications following acute myocardial infarction (AMI)¹ and was successfully deployed at an academic hospital.¹ We desired to implement AGM in the community-hospital setting and surveyed medical staff at one community hospital to determine their potential acceptance of this technology.

Methods

In July 2004, a 21-item questionnaire was mailed to 865 physicians in medical and surgical specialties who were on staff at Missouri Baptist Medical Center. Items assessed:

• Knowledge of CHD-prevention guidelines (True/False and multiple selection)

• Attitudes toward automatic lipid profiles on inpatients with elevated troponin-I within 24 hours of admission and toward physician openness to pharmacists’ recommendations for CHD-prevention medications (5-point Likert scale “Strongly disagree” to “Strongly agree”)

• Likelihood of prescribing CHD-prevention medications based on recommendation by a pharmacist (5-point scale from “Not at all likely” to “Extremely likely”)

• Gender, age, and specialty

Results

Respondents included 245 physicians (82% men; 20% in surgery, 10% in cardiology, 36% in general practice, and 34% were in various other specialties. Mean age of respondents was 49 years (range 30–79). Respondents and non-respondents did not differ significantly by age or gender. Physicians admitting an AMI patient last year were more likely than physicians not admitting an AMI patient to return a survey (51.4% vs. 22.5%; p < .001).

Respondents’ mean knowledge score was 10 of 14 possible (range 0–14). Mean knowledge was higher for cardiologists and physicians in general-practice specialties compared with surgeons and physicians in other specialties (11.9 vs. 11.0 vs. 8.7 vs. 9.3, respectively; ANOVA p < .001). Knowledge was correlated with the likelihood of prescribing CHD-prevention medications based on a pharmacist’s recommendation (r = .221, p = .001) and with the belief that the lab should automatically perform a lipid profile for inpatients with elevated troponin (r = .209, p = .001). Knowledge did not correlate with the extent to which respondents would welcome a pharmacist approach them with therapeutic recommendations (r = −.049, p = .450).

About half (51.7%) agreed or strongly agreed that the lab should automatically perform a lipid profile for inpatients with elevated troponin-I levels within 24 hours of admission; 57.8% agreed or strongly agreed that they would welcome having a pharmacist make therapeutic recommendations for CHD-prevention medications. Finally, 65.7% of the respondents reported being very likely or extremely likely to prescribe a pharmacist’s recommended CHD-prevention medication.

Conclusions

Respondents were moderately knowledgeable of CHD-prevention guidelines and little more than half indicated agreement with automatic lipid profiles for inpatients with elevated troponin-I and with welcoming therapeutic recommendations by a pharmacist. A post-intervention survey will assess changes in physicians’ knowledge, attitudes, and likelihood of prescribing medications based on a pharmacist's recommendation.