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Which doctors are influenced by a patient's age? A multimethod study of angina treatment in general practice, cardiology and gerontology

Harries, C; Forrest, D; Harvey, N; McClelland, A; Bowling, A; (2007) Which doctors are influenced by a patient's age? A multimethod study of angina treatment in general practice, cardiology and gerontology. Quality and Safety in Health Care , 16 (1) 23 - 27. 10.1136/qshc.2006.018036. Green and gold open access

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Abstract

Background: Elderly patients with cardiovascular disease are relatively undertreated and undertested.Objectives: To investigate whether, and how, individual doctors are influenced by a patient's age in their investigation and treatment of angina.Design: Process-based judgment analysis using electronic patients, semistructured interviews.Setting: Primary Care, Care of the Elderly and Cardiology in England.Participants: Eighty five doctors: 29 cardiologists, 28 care of the elderly specialists and 28 general practitioners (GPs).Main outcome measures: Testing and treatment decisions on hypothetical patients.Results: Forty six per cent of GPs and care of the elderly doctors, and 48% of cardiologists treated patients aged 65+ differently to those under 65, independent of comorbidity. This effect was evident on several decisions: elderly patients were less likely to be prescribed a statin given a cholesterol test, referred to a cardiologist, given an exercise tolerance test, angiography and revascularisation; more likely to have their current prescriptions changed and to be given a follow-up appointment. There was no effect of specialty, gender or years of training on influence of patient age. Those doctors who were influenced by age were on average five years older than those who were not. Interviews revealed that some doctors saw old age as a contraindication to treat.Conclusions: Age, independent of comorbidity, presentation and patients' wishes, directly influenced decision-making about angina investigation and treatment by half of the doctors in the primary and secondary care samples. Doctors explicitly reasoned about the direct influence of age and age-associated influences.

Type:Article
Title:Which doctors are influenced by a patient's age? A multimethod study of angina treatment in general practice, cardiology and gerontology
Open access status:An open access publication. A version is also available from UCL Discovery.
DOI:10.1136/qshc.2006.018036
Publisher version:http://dx.doi.org/10.1136/qshc.2006.018036
Language:English
Keywords:ACUTE MYOCARDIAL-INFARCTION, CORONARY-HEART-DISEASE, SECONDARY PREVENTION, MANAGEMENT, SEX, SURGERY, RACE
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Brain Sciences > Psychology and Language Sciences (Division of) > Experimental Psychology
UCL > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Primary Care and Population Health

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