OBJECTIVE: The aim of this study was to explore and compare treatment decisions and the influence of specific patient characteristics on asthma management in five European countries, and to relate this to existing guidelines. METHODS: Using the technique of clinical judgement analysis, doctors in The Netherlands, Norway, Germany, Sweden and the Slovak Republic (40-100 doctors per country) were presented with sets of written simulated cases on asthma treatment. Patient characteristics were varied to determine their influence on the doctors' decisions. Decisions indicating over- and under-prescribing in relation to a gold standard derived from guidelines were also determined. RESULTS: Doctors in The Netherlands prescribed more oral steroid courses and fewer antibiotics than doctors in Norway and Sweden, whereas doctors in Germany and the Slovak Republic prescribed the least oral steroids and the most antibiotics. Partially, this variation could be explained by differences in the underlying propensity to prescribe, but differences in the use of patient characteristics also contributed to the variation. Norwegian doctors were most inclined to increase the maintenance treatment of inhaled corticosteroids, which could best be explained by their relatively high focus on the patient's peak expiratory flow value. Compared with the gold standard, there was 25-56% under-prescribing of oral steroids, and 21-45% over-prescribing of antibiotics. CONCLUSIONS: The variation in treatment of asthma patients between doctors in different countries may, in part, be attributed to variations in the underlying propensity to prescribe, and in part to different use of clinical patient characteristics. These findings can be used in tailoring educational programmes to improve treatment practices.
OBJECTIVE: The aim of this study was to explore and compare treatment decisions and the influence of specific patient characteristics on asthma management in five European countries, and to relate this to existing guidelines. METHODS: Using the technique of clinical judgement analysis, doctors in The Netherlands, Norway, Germany, Sweden and the Slovak Republic (40-100 doctors per country) were presented with sets of written simulated cases on asthma treatment. Patient characteristics were varied to determine their influence on the doctors' decisions. Decisions indicating over- and under-prescribing in relation to a gold standard derived from guidelines were also determined. RESULTS: Doctors in The Netherlands prescribed more oral steroid courses and fewer antibiotics than doctors in Norway and Sweden, whereas doctors in Germany and the Slovak Republic prescribed the least oral steroids and the most antibiotics. Partially, this variation could be explained by differences in the underlying propensity to prescribe, but differences in the use of patient characteristics also contributed to the variation. Norwegian doctors were most inclined to increase the maintenance treatment of inhaled corticosteroids, which could best be explained by their relatively high focus on the patient's peak expiratory flow value. Compared with the gold standard, there was 25-56% under-prescribing of oral steroids, and 21-45% over-prescribing of antibiotics. CONCLUSIONS: The variation in treatment of asthma patients between doctors in different countries may, in part, be attributed to variations in the underlying propensity to prescribe, and in part to different use of clinical patient characteristics. These findings can be used in tailoring educational programmes to improve treatment practices.
Authors: David Darmon; Laurent Laforest; Eric Van Ganse; Ferdinando Petrazzuoli; Chris van Weel; Laurent Letrilliart Journal: BMC Fam Pract Date: 2015-02-06 Impact factor: 2.497
Authors: Trung N Tran; Elizabeth King; Rajiv Sarkar; Cassandra Nan; Annalisa Rubino; Caroline O'Leary; Ruvimbo Muzwidzwa; Laura Belton; Jennifer K Quint Journal: Eur Respir J Date: 2020-06-04 Impact factor: 16.671
Authors: Leila Karimi; Susanne J Vijverberg; Marjolein Engelkes; Natalia Hernandez-Pacheco; Niloufar Farzan; Patricia Soares; Maria Pino-Yanes; Andrea L Jorgensen; Celeste Eng; Somnath Mukhopadhyay; Maximilian Schieck; Michael Kabesch; Esteban G Burchard; Fook Tim Chew; Yang Yie Sio; Uroš Potočnik; Mario Gorenjak; Daniel B Hawcutt; Colin N Palmer; Steve Turner; Hettie M Janssens; Anke H Maitland-van der Zee; Katia M C Verhamme Journal: Clin Exp Allergy Date: 2021-07-20 Impact factor: 5.401
Authors: Lucas M Bachmann; Andrea Mühleisen; Annekatrin Bock; Gerben ter Riet; Ulrike Held; Alfons G H Kessels Journal: BMC Med Res Methodol Date: 2008-07-30 Impact factor: 4.615