Journal article
Reasons for not prescribing guideline-recommended medications to adults with heart failure
Medical care, Vol.51(10), pp.901-907
10/2013
DOI: 10.1097/MLR.0b013e3182a3e525
PMCID: PMC3806480
PMID: 23969589
Abstract
Background: Little is known about how often contextual factors such as patient preferences and competing priorities impact prescribing of guideline-recommended medications, or about the extent to which these factors are documented in medical records and available to performance measurement systems.
Methods: Mixed-methods study of 295 veterans aged 50 years and older in 4 VA health care systems who had systolic heart failure and were not prescribed a β-blocker and/or an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker. Reasons for nontreatment were identified from clinic notes and from interviews with 62 primary care clinicians caring for these patients. These reasons were classified using a published taxonomy.
Results: Among 295 patients not receiving guideline-recommended drugs for heart failure, chart review identified biomedical reasons for nonprescribing in 42%-58% of patients and contextual reasons in 11%-17%. Clinician interviews identified twice as many reasons for nonprescribing as chart review (mean 1.6 vs. 0.8 reasons per patient, P<0.001). In these interviews, biomedical reasons for nonprescribing were cited in 50%-70% of patients, and contextual reasons in 64%-70%. The most common contextual reasons were comanagement with other clinicians (32%-35% of patients), patient preferences and nonadherence (15%-24%), and clinician belief that the medication is not indicated in the patient (12%-20%).
Conclusions: Contextual reasons for not prescribing angiotensin converting enzyme inhibitor / angiotensin-receptor blockers and β-blockers are present in two thirds of patients with heart failure who did not receive these medications, yet are poorly documented in medical records. The structure of medical records should be improved to facilitate documentation of contextual reasons for not providing guideline-recommended care.
Details
- Title: Subtitle
- Reasons for not prescribing guideline-recommended medications to adults with heart failure
- Creators
- Peter J Kaboli - Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Healthcare System and the University of Iowa Carver College of Medicine; Iowa City VA Medical Center; 601 Highway 6 West; Iowa City, IA 52246-2208Michael A Steinman - HSR&D Research Enhancement Award Program, San Francisco VA Medical Center and the University of California, San Francisco; San Francisco VA Medical Center Box 181G; 4150 Clement St; San Francisco, CA 94121Liezel Dimaano - University of California, San Francisco; c/o UCSF School of Medicine, Dean's Office; 513 Parnassus Ave; San Francisco, CA 94143-0410Carolyn A Peterson - Department of Psychology, University of Oregon ; Straub Hall 1227; University of Oregon; Eugene, OR 97403Paul A Heidenreich - Palo Alto VA Health Care System and Stanford University; VA Palo Alto Medical Center; 111C Cardiology; 3801 Miranda Avenue; Palo Alto, CA 94304Sara J Knight - VA HSR&D Service and Associate Professor of Psychiatry and Urology, University of California, San Francisco; VA HSR&D Central Office; 810 Vermont Ave., NW; Washington, DC, 20420Kathy Z Fung - San Francisco VA Medical Center; San Francisco VA Medical Center, Box 181G; 4150 Clement St; San Francisco, CA 94121
- Resource Type
- Journal article
- Publication Details
- Medical care, Vol.51(10), pp.901-907
- DOI
- 10.1097/MLR.0b013e3182a3e525
- PMID
- 23969589
- PMCID
- PMC3806480
- NLM abbreviation
- Med Care
- ISSN
- 0025-7079
- eISSN
- 1537-1948
- Publisher
- Ovid Technologies (Wolters Kluwer Health)
- Grant note
- K23 AG030999 || AG / National Institute on Aging : NIA
- Language
- English
- Date published
- 10/2013
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984094540802771
Metrics
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