Determinants for the adoption of angiotensin II receptor blockers by general practitioners
Determinants for the adoption of angiotensin II receptor blockers by general practitioners
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DOI：
10.1016/j.socscimed.2006.07.019
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发表时间：
2006-12-01
影响因子：
5.4
通讯作者：
Haaijer-Ruskamp, Flora M.
中科院分区：
文献类型：
--
作者：
Greving, Jacoba P.;Denig, Petra;Haaijer-Ruskamp, Flora M.
10-20年前进行的研究结果表明，商业信息源在新药采用过程中占有重要地位。在过去的十年里，越来越多的人强调在药物处方中实践循证医学。这就提出了一个问题，即专业信息源目前是否在采用过程中抵消了商业信息源的影响。本研究的目的是确定影响荷兰全科医生（CPs）采用一类新药血管紧张素II受体阻滞剂（ARBs）的决定因素。使用综合初级保健信息（IPCI）数据库，进行了一项回顾性研究，以评估高血压患者普遍的ARB处方。我们对2003年参与IPCI项目的所有全科医生进行了一项调查，以评估他们对商业和专业信息源的接触情况、arb的感知利益和风险、专业网络的感知影响以及一般特征。应用多水平逻辑回归来确定采用ARB的决定因素，同时调整患者特征。数据来自70名全科医生和9470名高血压患者。1093例患者接受arb治疗（12%）。报告经常使用商业信息源的全科医生更有可能常规地开arb而不是其他抗高血压药物，而使用处方决策支持系统和参与药物治疗教育的全科医生不太可能开arb。与ARB采用率较高相关的其他因素包括对ARB降低血压的有效性的更积极的看法，以及在单人执业或在农村地区工作。除了与患者群体相关的决定因素外，荷兰全科医生对新药类别的采用仍然更多地取决于他们对促销信息的依赖，而不是他们对专业信息源的使用。(c) 2006 Elsevier Ltd.版权所有。
Results of studies conducted 10-20 years ago show the prominence of commercial information sources in the adoption process of new drugs. Over the past decade, there has been a growing emphasis on practicing evidence-based medicine in drug prescribing. This raises the question whether professional information sources currently counterbalance the influence of commercial information sources in the adoption process. The aim of this study was to identify determinants influencing the adoption of a new drug class, the angiotensin II receptor blockers (ARBs), by general practitioners (CPs) in The Netherlands. A retrospective study was conducted to assess prevalent ARB prescribing for hypertensive patients,using the Integrated Primary Care Information (IPCI) database. We conducted a survey among all GPs who participated in the IPCI project in 2003 to assess their exposure to commercial and professional information sources, perceived benefits and risks of ARBs, perceived influences of the professional network, and general characteristics. Multilevel logistic regression was applied to identify determinants of ARB adoption while adjusting for patient characteristics. Data were obtained from 70 GPs and 9470 treated hypertensive patients. A total of 1093 patients received ARBs (12%). GPs who reported frequent use of commercial information sources were more likely to prescribe ARBs routinely in preference to other antihypertensives, whereas GPs who used a prescribing decision support system and those who were involved in pharmacotherapy education were less likely to prescribe ARBs. Other factors that were associated with higher levels of ARB adoption included a more positive perception of ARBs regarding their effectiveness in lowering blood pressure, and working in single-handed practices or in rural areas. Aside from determinants related to the patient population, adoption of a new drug class among Dutch GPs is still determined more by their reliance on promotional information than by their use of professional information sources. (c) 2006 Elsevier Ltd. All rights reserved.