Factors impacting physicians’ decisions to prevent variceal hemorrhage

BMC Gastroenterology

Liana Fraenkel²  Guadalupe Garcia-Tsao²  Loren Laine²  Salvador Augustin²  John FP Bridges¹  Kathleen Yan² 

[1] Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA

关键词: Best worst scaling;    Discrete choice;    Treatment preferences;    Variceal hemorrhage;   

Others  :  1211533
DOI  :  10.1186/s12876-015-0287-1

 received in 2014-12-15, accepted in 2015-04-27,  发布年份 2015

【 摘 要 】

Background

Reasons underlying the variability of physicians’ preferences for non-selective beta-blockers (BBs) and endoscopic variceal ligation (EVL) to prevent a first variceal bleed have not been empirically studied. Our aims were to examine whether 1) gastroenterologists can be classified into distinct subgroups based on how they prioritize specific treatment attributes and 2) physician characteristics are associated with treatment preference.

Methods

We surveyed physicians to determine their preferred treatment for a standardized patient with large varices and examined the influence of treatment characteristics on physicians’ decision making using best-worst scaling. Latent class analysis was used to examine whether physicians could be classified into groups with similar decision-making styles.

Results

110 physicians were interviewed (participation rate 39%). The majority spent two or more days a week performing endoscopies and had practices comprising less than 25% of patients with liver disease. Latent class analysis demonstrated that physicians could be classified into at least two distinct groups. Most (n = 80, Group 1) were influenced solely by the ability to visually confirm eradication of varices. In contrast, members of Group 2 (n = 30) were influenced by the side effects and mechanism of action of BBs. Group 1 members were more likely to have practices that included fewer patients with liver disease and more likely to choose options including EVL (p = 0.01 for both).

Conclusions

Among physicians, where the majority performs endoscopy on two or more days per week, most prefer prevention strategies which include EVL. This may be due to the strong appeal of being able to visualize eradication of varices.

【 授权许可】

   
2015 Yan et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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