Variations in cardiac interventions: doctors' practices and views
Variations in cardiac interventions: doctors' practices and views
Objectives: To investigate referral rates for cardiac interventions by clinical specialty, to document doctors' reasons for referrals and to explore doctors' perceptions of the factors that influenced their clinical decisions.
Study design. Doctors completed a clinical decision-making exercise involving, in total, 6093 electronic patients with cardiac disease, and subsequently took part in the semi-structured interviews about influences on their decisions. Interviews were audio-recorded, transcribed and coded using a thematic approach, with the coding categories derived from the data.
Study setting: Eighty-eight doctors (GPs, care-of-the-elderly specialists, cardiologists) participated in the full study, in seven areas in southern, central and northern England. Complete interview data were analysed for 76 of these.
Principal findings: Not all patients who were eligible for specific investigations or treatment received these. The extent of variations in clinical decisions differed by type of intervention. Apart from the general reasons for referrals, doctors raised nine main influences on their actual decision making. The most commonly reported influence (‘barrier’) was poor access to equipment for intervention, which increased thresholds for investigation and treatment.
Conclusions: The current emphasis on achieving targets in the British NHS has led to a focus on easily measurable, but crude, process targets such as waiting lists. This study points to the need to include a broader quality assurance element to investigate the cluster of system failures which lead to variations in clinical decisions and thereby to inequitable treatment.
cardiology, coronary angiography, decision making, exercise test, family practice, heart diseases, interviews as topic, outcome assessment (health care), physician's practice patterns, primary health care, quality assurance, referral and consultation, waiting lists
427 - 436
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
24 January 2006
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
Bowling, Ann, Harries, Clare, Forrest, Damien and Harvey, Nigel
(2006)
Variations in cardiac interventions: doctors' practices and views.
Family Practice, 23 (4), .
(doi:10.1093/fampra/cmi125).
(PMID:16611650)
Abstract
Objectives: To investigate referral rates for cardiac interventions by clinical specialty, to document doctors' reasons for referrals and to explore doctors' perceptions of the factors that influenced their clinical decisions.
Study design. Doctors completed a clinical decision-making exercise involving, in total, 6093 electronic patients with cardiac disease, and subsequently took part in the semi-structured interviews about influences on their decisions. Interviews were audio-recorded, transcribed and coded using a thematic approach, with the coding categories derived from the data.
Study setting: Eighty-eight doctors (GPs, care-of-the-elderly specialists, cardiologists) participated in the full study, in seven areas in southern, central and northern England. Complete interview data were analysed for 76 of these.
Principal findings: Not all patients who were eligible for specific investigations or treatment received these. The extent of variations in clinical decisions differed by type of intervention. Apart from the general reasons for referrals, doctors raised nine main influences on their actual decision making. The most commonly reported influence (‘barrier’) was poor access to equipment for intervention, which increased thresholds for investigation and treatment.
Conclusions: The current emphasis on achieving targets in the British NHS has led to a focus on easily measurable, but crude, process targets such as waiting lists. This study points to the need to include a broader quality assurance element to investigate the cluster of system failures which lead to variations in clinical decisions and thereby to inequitable treatment.
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More information
Published date: 24 January 2006
Keywords:
cardiology, coronary angiography, decision making, exercise test, family practice, heart diseases, interviews as topic, outcome assessment (health care), physician's practice patterns, primary health care, quality assurance, referral and consultation, waiting lists
Organisations:
Faculty of Health Sciences
Identifiers
Local EPrints ID: 334588
URI: http://eprints.soton.ac.uk/id/eprint/334588
ISSN: 0263-2136
PURE UUID: 1243eefe-8048-4f84-8540-4dae5921dca4
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Date deposited: 30 Mar 2012 13:08
Last modified: 14 Mar 2024 10:35
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Contributors
Author:
Clare Harries
Author:
Damien Forrest
Author:
Nigel Harvey
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