Factors impacting physicians’ decisions to prevent variceal hemorrhage

BMC Gastroenterology

Research Article

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

[1] Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Section of Rheumatology, Yale University School of Medicine, P.O. Box 208031, 300 Cedar ST, TAC Bldg, RM #525, New Haven, CT, USA;Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Health Care System, West Haven, CT, USA;

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

DOI  :  10.1186/s12876-015-0287-1

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

来源: Springer

【 摘 要 】

BackgroundReasons 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.MethodsWe 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.Results110 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).ConclusionsAmong 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】

Unknown   
© Yan et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.