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Anticoagulation for nonvalvular atrial fibrillation: effects of type of practice on physicians' self-reported
1Department of Medicine, The Center on Aging, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
Insights
Physician prescribing of warfarin for nonvalvular atrial fibrillation (AF) was linked to the proportion of Medicaid patients. Socioeconomic factors influenced anticoagulant use in this patient group.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Investigating the influence of socioeconomic factors on clinical practice for nonvalvular atrial fibrillation (AF).
- Understanding physician attitudes and practices regarding warfarin anticoagulation in AF patients.
Purpose of the Study:
- To determine if social and economic factors impact physician prescribing of warfarin for nonvalvular AF.
- To analyze the relationship between physician practice patterns and patient socioeconomic status.
Main Methods:
- Surveyed 358 physicians (GPs, internists, cardiologists) in three Maryland counties.
- Physicians were selected based on prescribing digitalis compounds in the prior year.
- Response rate was 43%.
Main Results:
- Physicians prescribing more digitalis for Medicaid patients used warfarin less for nonvalvular AF (66% vs. 79%, P <0.01).
- Aspirin use showed an inverse relationship with Medicaid patient proportion.
- No significant urban vs. suburban practice differences were observed.
Conclusions:
- Physician self-reported anticoagulant practices for nonvalvular AF correlate with the percentage of digitalis prescriptions for Medicaid patients.
- Approximately 75% of nonvalvular AF patients in this metropolitan area received anticoagulant therapy.
Background:
This study examines whether social and economic factors affect physician practice and attitude with regard to warfarin anticoagulation in patients with nonvalvular atrial fibrillation.
Methods:
We identified physicians in Baltimore City, Baltimore County, and Prince George's County who (1) had written one or more prescriptions for a digitalis compound during the preceding year, and (2) were classified as general practitioners, family practice specialists, internists, or cardiologists. All 358 physicians fulfilling these criteria were surveyed by questionnaire.
Results:
The overall response rate was 43%. Physicians who wrote 15% or more of their digitalis prescriptions for Medicaid patients said they used warfarin at significantly lower rates for patients with nonvalvular AF than other (66% versus 79%, P <0.01). The opposite pattern was seen with regard to aspirin. There were no significant differences in practice pattern between physicians located in urban vs. suburban counties.
Conclusion:
In our sample, self-reported anticoagulant practices for patients with nonvalvular AF were associated with the percentage of digitalis prescriptions written for Medicaid patients. In this metropolitan area, anticoagulant therapy was reportedly prescribed for approximately 75% of patients with nonvalvular atrial fibrillation.