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Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology

Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology
Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology
Background: Elderly patients with cardiovascular disease are relatively undertreated and undertested.
Objectives: To investigate whether, and how, individual doctors are influenced by a patient's age in their investigation and treatment of angina.
Design: Process-based judgment analysis using electronic patients, semistructured interviews.
Setting: Primary Care, Care of the Elderly and Cardiology in England.
Participants: Eighty five doctors: 29 cardiologists, 28 care of the elderly specialists and 28 general practitioners (GPs).
Main outcome measures: Testing and treatment decisions on hypothetical patients.
Results: Forty six per cent of GPs and care of the elderly doctors, and 48% of cardiologists treated patients aged 65+ differently to those under 65, independent of comorbidity. This effect was evident on several decisions: elderly patients were less likely to be prescribed a statin given a cholesterol test, referred to a cardiologist, given an exercise tolerance test, angiography and revascularisation; more likely to have their current prescriptions changed and to be given a follow-up appointment. There was no effect of specialty, gender or years of training on influence of patient age. Those doctors who were influenced by age were on average five years older than those who were not. Interviews revealed that some doctors saw old age as a contraindication to treat.
Conclusions: Age, independent of comorbidity, presentation and patients' wishes, directly influenced decision-making about angina investigation and treatment by half of the doctors in the primary and secondary care samples. Doctors explicitly reasoned about the direct influence of age and age-associated influences.
acute myocardial infarction, coronary heart disease, secondary prevention, management, sex, surgery, race
1475-3898
23 - 27
Harries, Clare
45108546-dd99-40b5-a565-b0e68af3e9ca
Forrest, Damien
5d428f75-6703-4742-b7c4-3b3b569610fa
Harvey, Nigel
2d45db27-4bde-456e-96f6-254a34f09d6f
McClelland, Alastair
f717ce3c-fe79-447c-bf5e-859909cd3a1f
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Harries, Clare
45108546-dd99-40b5-a565-b0e68af3e9ca
Forrest, Damien
5d428f75-6703-4742-b7c4-3b3b569610fa
Harvey, Nigel
2d45db27-4bde-456e-96f6-254a34f09d6f
McClelland, Alastair
f717ce3c-fe79-447c-bf5e-859909cd3a1f
Bowling, Ann
796ca209-687f-4079-8a40-572076251936

Harries, Clare, Forrest, Damien, Harvey, Nigel, McClelland, Alastair and Bowling, Ann (2007) Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology. Quality and Safety in Health Care, 16 (1), 23 - 27. (doi:10.1136/qshc.2006.018036). (PMID:17301199)

Record type: Article

Abstract

Background: Elderly patients with cardiovascular disease are relatively undertreated and undertested.
Objectives: To investigate whether, and how, individual doctors are influenced by a patient's age in their investigation and treatment of angina.
Design: Process-based judgment analysis using electronic patients, semistructured interviews.
Setting: Primary Care, Care of the Elderly and Cardiology in England.
Participants: Eighty five doctors: 29 cardiologists, 28 care of the elderly specialists and 28 general practitioners (GPs).
Main outcome measures: Testing and treatment decisions on hypothetical patients.
Results: Forty six per cent of GPs and care of the elderly doctors, and 48% of cardiologists treated patients aged 65+ differently to those under 65, independent of comorbidity. This effect was evident on several decisions: elderly patients were less likely to be prescribed a statin given a cholesterol test, referred to a cardiologist, given an exercise tolerance test, angiography and revascularisation; more likely to have their current prescriptions changed and to be given a follow-up appointment. There was no effect of specialty, gender or years of training on influence of patient age. Those doctors who were influenced by age were on average five years older than those who were not. Interviews revealed that some doctors saw old age as a contraindication to treat.
Conclusions: Age, independent of comorbidity, presentation and patients' wishes, directly influenced decision-making about angina investigation and treatment by half of the doctors in the primary and secondary care samples. Doctors explicitly reasoned about the direct influence of age and age-associated influences.

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More information

Published date: February 2007
Keywords: acute myocardial infarction, coronary heart disease, secondary prevention, management, sex, surgery, race
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 334574
URI: http://eprints.soton.ac.uk/id/eprint/334574
ISSN: 1475-3898
PURE UUID: a6ac6964-3c06-41c3-9d5c-e14c2203c4f2

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Date deposited: 30 Mar 2012 11:33
Last modified: 16 Jul 2019 22:09

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