The impact of physician attitudes and beliefs on treatment decisions - Lipid therapy in high-risk patients

Background: Despite clinical guidelines, many patients with hyper cholesterolemia do not achieve treatment goals in clinical practice. Objectives: This study examined physician attitudes and beliefs about hyperlipidmia and whether they are associated with lipid treatment decisions. Methods: This was a cross-sectional study of 107 physicians who completed a validated survey of attitudes and beliefs about hyperlipidemia and provided treatment histories for 1187 statin-treated patients with coronary heart disease (CHD) or who were CHD risk-equivalent. Logistic regressions (using generalized estimating equation) estimated the impact of patient characteristics and physician attitudes and beliefs on whether a patient received increases in the statin dose. Results: Approximately 70% of the 843 patients who were not at low-density lipoprotein cholesterol goal (< 100 mg/dL) with initial statin therapy received a dose increase, although only one-half attained goal. Controlling for patient characteristics, patients whose physicians believed "close enough to goal is good enough" had 47% lower odds of having a dose increase (odds ratio [OR], 0.53; 95% confidence interval [CI] ,0.34-0.82), whereas patients whose physicians believed "statins are effective" had almost twice the odds of having a dose increase (OR, 1.78; 95% Cl, 1.05-3.00). Conclusions: Although the understanding of basic and clinical science remains fundamental, clinical guideline authors may want to consider the importance of physician attitudes and beliefs in determining translation of their guidelines into clinical practice.