Physician beliefs, attitudes, and prescribing behavior for anti-inflammatory drugs

Psychologists have distinguished between "beliefs" and "attitudes" to help explain human behavior. To investigate the relationship between physician beliefs, attitudes, and their prescribing behavior for anti-inflammatory medication, 30 doctors in two Veterans Administration clinics were surveyed by questionnaire, and 1,265 of their prescriptions were collected. Their estimates of drug costs and the percent of patients who would have response to therapy or side effects were considered "beliefs." The "attitudes" measured were the relative importance physicians placed on six factors when choosing therapy: effectiveness, side effects, likelihood of compliance, placebo effect, cost, and the patient's perception of the physician. Physicians believed that efficacy of the different proprietary nonsteroidal anti-inflammatory agents and aspirin compounds was comparable. They perceived indomethacin as more toxic than other nonsteroidal anti-inflammatory drugs (p less than 0.01), and enteric-coated aspirin as less toxic than plain aspirin (p less than 0.01). Physicians wrote 5.7 times as many prescriptions for proprietary nonsteroidal anti-inflammatory agents as for aspirin compounds. A correlation was not observed between relative use of proprietary agents versus aspirin compounds and beliefs about costs, response rates, or side effects rates; however, attitudes regarding the importance of cost and placebo effects were correlated with prescribing behavior (p less than 0.05).