Quality of cardiovascular disease preventive care and physician/practice characteristics

AbstractBACKGROUND: Quality of cardiovascular disease (CVD) preventive care is suboptimal. Recent data correlated increasing years in practice for physicians with lower-quality health care. OBJECTIVE: The purpose of this study was to assess physician awareness/adherence to national blood pressure, cholesterol, and CVD prevention guidelines for women according to physician/practice characteristics. DESIGN: Standardized online survey and experimental case studies were administered to 500 randomly selected U.S. physicians. Multivariable regression models tested physician age, gender, specialty, and practice type as independent predictors of guideline awareness/adherence. RESULTS: Compared with older physicians (50+ years), younger physicians (<50 years) reported a lower level of awareness of cholesterol guidelines (P=.04) and lower incorporation of women’s guidelines (P=.02). Yet, older physicians were less likely to recommend weight management for high-risk cases (P=.03) and less confident in helping patients manage weight (P=.045) than younger physicians. Older physicians were also less likely to identify a low-density lipoprotein <100 mg/dL as optimal versus younger physicians (P=.01), as were solo versus nonsolo practitioners (P=.02). Solo practitioners were less aware of cholesterol guidelines (P=.04) and were more likely to prescribe aspirin for low-risk female patients than nonsolo practitioners (P<.01). Solo practitioners rated their clinical judgment as more effective than guidelines in improving patient health outcomes (P<.01) and more frequently rated the patient as the greatest barrier to CVD prevention versus nonsolo practitioners (P<.01). CONCLUSIONS: Though guideline awareness is high, efforts to promote their utilization are needed and may improve quality outcomes. Targeted education and support for CVD prevention may be helpful to older and solo physicians.