Physician Perspectives on Real-World Evidence for Prescribing to Older Patients

BackgroundAvailable evidence for many prescription drugs comes from clinical trials that often exclude older patients. Real-world evidence (RWE) generated post-approval can provide new evidence on effectiveness and safety for these populations. We sought to understand physicians' perceptions of clinical trial and RWE for prescribing decisions. To frame the study, we used examples of drugs for heart failure and anticoagulation, which are more like to be prescribed to older adults.MethodsWe conducted an interview study of 15 US physicians specializing in geriatrics, cardiology, or primary care and affiliated with academic medical centers. Interviews were coded using a qualitative thematic analysis approach to construct themes and identify patterns in responses.ResultsAll participants described limitations in current believed real-world evidence could help inform patient care and their practice. However, they had concerns about the data. If clinical trial and RWE findings diverged, all would need more information to determine which findings to follow.ConclusionsPhysicians who routinely prescribe to older patients are optimistically cautious about RWE for drugs but would rely on trusted sources, like professional society guidelines, for incorporating it into practice. Therefore, RWE researchers should identify opportunities to work alongside guideline developers and database editors on the practice-relevant interpretation and dissemination of the evidence.