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Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study

BACKGROUND: Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. METHODS: A qualitative study with semi-structure...

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Detalles Bibliográficos
Autores principales: AB, Elisabeth, Denig, Petra, van Vliet, Ton, Dekker, Janny H
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676243/
https://www.ncbi.nlm.nih.gov/pubmed/19383116
http://dx.doi.org/10.1186/1471-2296-10-24
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author AB, Elisabeth
Denig, Petra
van Vliet, Ton
Dekker, Janny H
author_facet AB, Elisabeth
Denig, Petra
van Vliet, Ton
Dekker, Janny H
author_sort AB, Elisabeth
collection PubMed
description BACKGROUND: Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. METHODS: A qualitative study with semi-structured interviews using real cases was conducted to explore reasons for not prescribing lipid-lowering medication after a guideline was distributed that recommended the use of statins in most patients with type 2 diabetes. Seven interviews were conducted with general practitioners (GPs) in The Netherlands, and analysed using an analytic inductive approach. RESULTS: Reasons for not-prescribing could be divided into patient and physician-attributed factors. According to the GPs, some patients do not follow-up on agreed medication and others object to taking lipid-lowering medication, partly for legitimate reasons such as expected or perceived side effects. Furthermore, the GPs themselves perceived reservations for prescribing lipid-lowering medication in patients with short life expectancy, expected compliance problems or near goal lipid levels. GPs sometimes postponed the start of treatment because of other priorities. Finally, barriers were seen in the GPs' practice organisation, and at the primary-secondary care interface. CONCLUSION: Some of the barriers mentioned by GPs seem to be valid reasons, showing that guideline non-adherence can be quite rational. On the other hand, treatment quality could improve by addressing issues, such as lack of knowledge or motivation of both the patient and the GP. More structured management in general practice may also lead to better treatment.
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spelling pubmed-26762432009-05-03 Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study AB, Elisabeth Denig, Petra van Vliet, Ton Dekker, Janny H BMC Fam Pract Research Article BACKGROUND: Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. METHODS: A qualitative study with semi-structured interviews using real cases was conducted to explore reasons for not prescribing lipid-lowering medication after a guideline was distributed that recommended the use of statins in most patients with type 2 diabetes. Seven interviews were conducted with general practitioners (GPs) in The Netherlands, and analysed using an analytic inductive approach. RESULTS: Reasons for not-prescribing could be divided into patient and physician-attributed factors. According to the GPs, some patients do not follow-up on agreed medication and others object to taking lipid-lowering medication, partly for legitimate reasons such as expected or perceived side effects. Furthermore, the GPs themselves perceived reservations for prescribing lipid-lowering medication in patients with short life expectancy, expected compliance problems or near goal lipid levels. GPs sometimes postponed the start of treatment because of other priorities. Finally, barriers were seen in the GPs' practice organisation, and at the primary-secondary care interface. CONCLUSION: Some of the barriers mentioned by GPs seem to be valid reasons, showing that guideline non-adherence can be quite rational. On the other hand, treatment quality could improve by addressing issues, such as lack of knowledge or motivation of both the patient and the GP. More structured management in general practice may also lead to better treatment. BioMed Central 2009-04-21 /pmc/articles/PMC2676243/ /pubmed/19383116 http://dx.doi.org/10.1186/1471-2296-10-24 Text en Copyright © 2009 AB et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
AB, Elisabeth
Denig, Petra
van Vliet, Ton
Dekker, Janny H
Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
title Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
title_full Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
title_fullStr Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
title_full_unstemmed Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
title_short Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
title_sort reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676243/
https://www.ncbi.nlm.nih.gov/pubmed/19383116
http://dx.doi.org/10.1186/1471-2296-10-24
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