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Biomedical subjects

Andreas Laupacis

Publications and source records attributed to Andreas Laupacis.

At least 55 records · Page 3Linked to original sources
PubMed2004

Effect of age on the use of evidence-based therapies for acute myocardial infarction.

BACKGROUND: Previous studies have documented an underuse of evidence-based therapies in patients with acute myocardial infarction (AMI). However, many of these studies failed to consider contraindications to therapy, the effect of age (ie, elderly vs non-elderly patients) on use, or both. The objective of this study was to determine whether elderly patients are less likely than non-elderly patients to receive evidence-based AMI treatments, both before and after the consideration of contraindications to therapy. METHODS: A retrospective chart review of a random sample of 5131 patients with AMI who were admitted to 1 of 44 hospitals in Ontario was conducted for the fiscal years 1994 to 1996. Using the Canadian Cardiovascular Research Team (CCORT)/Canadian Cardiovascular Society (CCS) Quality Indicators for AMI Care, we classified patients as being eligible or ideal (ie, no contraindications to treatment) candidates to receive aspirin, beta-blockers, thrombolysis, angiotensin-converting enzyme inhibitors (ACEIs), or statins or to undergo lipid profiling. The proportions of eligible and ideal patients who received treatment were calculated, and the latter were compared with benchmarks. RESULTS: The median age of the cohort was 69 years; 63% were of the patients were aged > or =65 years. There was underperformance of prescribing treatments in ideal candidates relative to benchmarks (eg, aspirin at discharge: 78.6% vs 90% benchmark). The odds of ideal (ie, no contraindications) elderly candidates receiving various evidence-based AMI treatments were consistently less than that of non-elderly patients with AMI, with the exception of ACEIs at discharge (odds ratio, 1.46; 95% CI, 1.22-1.74). CONCLUSIONS: Despite adjustments for contraindications to therapy, the underuse of AMI treatments, particularly in elderly patients, was found.

Adrenergic beta-Antagonists↗
PubMed2004

Predictors of repair and effect of gender on treatment of ruptured abdominal aortic aneurysm.

OBJECTIVE: The purpose of this study was to determine factors associated with increased likelihood of patients undergoing surgery to repair ruptured abdominal aortic aneurysms (AAAs). Specifically, we investigated whether men were more likely than women to be selected for surgery after rupture of AAAs. METHODS: All patients with a ruptured AAA who came to a hospital in Ontario between April 1, 1992, and March 31, 2001, were included in this population-based retrospective study. Administrative data were used to identify patients, patient demographic data, and hospital variables. RESULTS: Crude 30-day mortality for the 3570 patients who came to a hospital with a ruptured AAA was 53.4%. Of the 2602 patients (72.9%) who underwent surgical repair, crude 30-day mortality was 41.0%. Older patients (odds ratio [OR], 0.649 per 5 years of age; P<.0001), with a higher Charlson Comorbidity Index (OR, 0.848; P<.0001), were less likely to undergo AAA repair. Patients treated at high-volume centers (OR, 2.674 per 10 cases; P<.0001) and men (OR, 2.214; P<.0001) were more likely to undergo AAA repair. CONCLUSION: Men are more likely to undergo repair of a ruptured AAA than women are, for reasons that are unclear. Given the large magnitude of the effect, further studies are clearly indicated.

Aged↗
PubMed2004

Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors.

OBJECTIVE: The purpose of this study was to determine the effects of patient, surgeon, and hospital factors on survival after repair of ruptured abdominal aortic aneurysm (AAA) and to compare them with risk factors for survival after elective AAA repair. It was hypothesized that patients operated on by high-volume surgeons with subspecialty training would have better outcomes, which might argue for regionalization of AAA surgery. METHODS: In this population-based retrospective cohort study, surgeon billing and administrative data were used to identify all patients who had undergone AAA repair between April 1, 1992, and March 31, 2001, in Ontario, Canada. Demographic information was collected for each patient, as well as numerous variables related to the surgeons and hospitals. RESULTS: There were 2601 patients with ruptured AAA repair, with an average 30-day mortality rate of 40.8%. Significant independent predictors of lower survival were older age, female gender, lower patient income quintile, performance of surgery at night or on weekends, repair in larger cities, surgeons with lower annual volume of ruptured AAA operations, and surgeons without vascular or cardiothoracic fellowship training. There were 13,701 patients with elective AAA repair, with an average 30-day mortality rate of 4.5%. Significant independent predictors of lower survival were similar, except gender was not significant, but the Charlson Comorbidity Index was. When the hazard ratios associated with predictive factors were compared, surgeon factors appeared to be more important in ruptured AAA repair, and patient factors appeared more important in elective AAA repair. CONCLUSION: For elective AAA repair, and even more so for ruptured AAA repair, high-volume surgeons with subspecialty training conferred a significant survival benefit for patients. Although this would seem to argue in favor of regionalization, decisions should await a more complete understanding of the relationship between transfer time, delay in treatment, and outcome.

Aged↗
PubMed2004

Long-term survival and temporal trends in patient and surgeon factors after elective and ruptured abdominal aortic aneurysm surgery.

OBJECTIVE: Records for all patients in Ontario who underwent elective repair of abdominal aortic aneurysms (AAAs) or repair of ruptured AAAs between 1993 and 1999 were studied to determine whether the profile of surgeons or patients changed and to determine whether postoperative mortality changed over time. The secondary objective was to describe long-term survival after AAA surgery. METHODS: A population-based retrospective cohort was assembled from administrative data. Surgeon billing records were used to identify operations performed between 1993 and 1999. Chi(2) and linear regression analyses were used to determine whether variables changed over time. Kaplan-Meier survival curves were used to estimate long-term survival. RESULTS: For patients undergoing elective AAA repair, average annual surgeon volume (P <.0001) and proportion of patients operated on by vascular surgeons (P =.02) increased over the study period; similar trends were noted for patients undergoing repair of ruptured AAAs. Surgeon volume was clearly correlated with mortality after both elective AAA repair and repair of ruptured AAAs; however, the benefit of this effect was modest beyond a surgeon volume of 6 to 10 ruptured AAA repairs per year or 20 to 30 elective AAA repairs per year. No change in crude 30-day mortality (4.5% for elective AAA repair and 40.4% for repair of ruptured AAAs) was noted during the study. CONCLUSION: Despite the finding that surgery to repair ruptured AAAs and elective repair of AAAs is being increasingly performed by high-volume vascular surgeons, there was no change in early mortality between 1993 and 1999. This may have been because average surgeon volume was already relatively high at the beginning of the study period, which translated into only modest benefit to further increases in surgeon volume.

Aged↗
PubMed2004

Differences between systematic reviews and health technology assessments: a trade-off between the ideals of scientific rigor and the realities of policy making.

OBJECTIVES: To elucidate important differences between a health technology assessment (HTA) and a systematic review, using an HTA of positron emission tomography (PET) as an example. METHODS: Interviews with seventeen individuals who were authors or users of the PET HTA. RESULTS: Those interviewed identified seven areas in which HTAs often differ from traditional systematic reviews: (i) methodological standards (HTAs may include literature of relatively poor methodological quality if a topic is of importance to decision-makers), (ii) replication of previous studies (relatively common for HTAs but not systematic reviews), (iii) choice of topics (more policy oriented for HTAs, while systematic reviews tend to be driven by researcher interest), (iv) inclusion of content experts and policy-makers as authors (policy-makers more likely to be included in HTAs, although there are potential conflicts of interest), (v) inclusion of economic evaluations (more often with HTAs, although economic evaluations based upon poor clinical data may not be useful), (vi) making policy recommendations (more likely with HTAs, although this must be done with caution), and (vii) dissemination of the report (more often actively done for HTAs). CONCLUSIONS: This case study of an HTA of PET scanning confirms that HTAs are a bridge between science and policy and require a balance between the ideals of scientific rigor and the realities of policy making.

Cost-Benefit Analysis↗
PubMed2004

Mechanical ventilation in Ontario, 1992-2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients.

OBJECTIVE: Mechanical ventilation is a common therapy used in caring for critically ill patients, but its epidemiology is poorly understood. We describe population-based, temporal trends in the incidence, survival, and hospital bed utilization of mechanically ventilated, noncardiac surgery adult patients. DESIGN: Retrospective, observational cohort study using linked administrative databases. SETTING: Province of Ontario, Canada. PATIENTS: Subjects were 150,755 unique patients who received mechanical ventilation between 1992 and 2000. INTERVENTIONS: None. MEASUREMENTS: Annual measures of mechanical ventilation incidence, 30-day patient mortality rate, and number of mechanical ventilation days and inpatient days for mechanically ventilated patients as a proportion of total adult inpatient bed days. MAIN RESULTS: From 1992 to 2000, the crude and age- and gender-adjusted incidence of mechanical ventilation increased 9% (p <.001) and 2% (p <.027), respectively, to 217 per 100,000 adults. Crude mortality rate 30 days after initiation of mechanical ventilation increased from 27% to 32% (p <.001). Significant predictors of 30-day mortality rate (adjusted hazard ratio, 95% confidence interval) were calendar year (1.03, 1.02-1.03), age >80 yrs (2.3, 2.2-2.3), Charlson score 3+ (2.0, 2.0-2.1), and specific diagnosis. From 1992 to 2000, the number of mechanical ventilation days and inpatient days for mechanically ventilated patients, as a proportion of total adult inpatient bed days, increased 69% and 30% (both p <.001), respectively, to 1.8% and 6.2%. CONCLUSIONS: There was a small, but important, increase in mechanical ventilation incidence and a substantial increase in the proportion of inpatient bed days used by mechanically ventilated patients in Ontario during the 1990s. These trends are important in planning for expansion of health care resources to meet the needs of the aging population. The increase, over time, in risk-adjusted mortality rate of mechanically ventilated patients is concerning and requires further investigation.

Adult↗
PubMed2004

Use of angiotensin-converting enzyme inhibitor therapy and dose-related outcomes in older adults with new heart failure in the community.

OBJECTIVE: To evaluate the dose-related benefit of angiotensin-converting enzyme (ACE) inhibitor therapy among older adults with heart failure and to evaluate whether low-dose ACE inhibitor therapy is better than none. DESIGN: Observational cohort study. SETTING: Community-dwelling older adults in Ontario, Canada. PATIENTS/PARTICIPANTS: We identified 16539 adults 66 years or older who survived 45 days following their first heart failure hospitalization discharge. MEASUREMENT AND MAIN RESULTS: Multivariate techniques including propensity scores were used to study the association between the dose of ACE inhibitor therapy dispensed and 3 outcomes: survival, survival or heart failure rehospitalization, and survival or all-cause hospitalization at 1 year of follow-up. Logistic regression models explored the association between initial dose dispensed and subsequent dose reduction or drug cessation. Overall, 10793 (65.3%) of patients were dispensed ACE inhibitor therapy, with more than a third (3935; 36.5%) initiated on low-dose therapy. Relative to dispensing of low-dose ACE inhibitor therapy, nonuse was associated with increased mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.02 to 1.22). Dispensing medium-dose therapy provided a benefit similar to low-dose (HR, 0.94; CI, 0.86 to 1.03) and dispensing of high-dose therapy was associated with improved survival benefit (HR, 0.76; CI, 0.68 to 0.85). Relative to dispensing of low-dose ACE inhibitor therapy, dispensing high-dose conferred a benefit (HR, 0.87; CI, 0.80 to 0.95) on the composite outcome of 1-year mortality or heart failure hospitalization and the composite outcome of 1-year mortality or all-cause hospitalization (HR, 0.87; CI, 0.81 to 0.93). Relative to those dispensed low-dose ACE inhibitor therapy, those initially dispensed high-dose therapy were twice as likely to have their subsequent dose reduced or the therapy discontinued (odds ratio, 2.36; CI, 2.07 to 2.69). CONCLUSION: Our findings suggest that when possible, older adults should be titrated to the higher doses of ACE inhibitor therapy evaluated in clinical trials. If older adults cannot tolerate higher doses, then low-dose ACE inhibitor therapy is superior to none. High-dose ACE inhibitor therapy is not as well tolerated as lower doses.

Aged↗
PubMed2004

Hard decisions about fundamental values.

The lead paper provides a helpful review of the implications of last-dollar and first-dollar reimbursement of pharmaceuticals. Yet, the issue is extremely complex, and there are no easy solutions. Ultimately, the benefits and costs of drugs will force us as a society to make some very hard decisions about fundamental human values such as access, equity and affordability.

Canada↗
PubMed2004

Antihypertensive therapy and incidence of type 2 diabetes: a systematic review.

OBJECTIVE: To systematically review the available evidence examining the effects of the major antihypertensive drug classes on the incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS: The Cochrane Controlled Trials Register, Medline, and Embase were searched for English-language case-control, cohort, and randomized controlled trials involving the major antihypertensive classes and reporting type 2 diabetes as an end point. Reference lists of original studies and narrative reviews were also hand searched. One reviewer (R.P.) performed the electronic searches. Both reviewers independently extracted data and assessed all potentially relevant studies for inclusion and methodological quality. Abstracts were not included, and unpublished studies were not sought. RESULTS: One case-control study, 8 cohort studies, and 14 randomized controlled trials met inclusion criteria. No study examined diabetes incidence as a primary end point. Poor methodological quality limits the conclusions that can be drawn from most nonrandomized trials. Evidence from randomized studies is also potentially limited by several sources of bias, including treatment contamination and bias inherent in post hoc analyses. Data from the highest-quality studies suggest that diabetes incidence is unchanged or increased by thiazide diuretics and beta-blockers and unchanged or decreased by ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers. CONCLUSIONS: The major antihypertensive classes may exert differential effects on diabetes incidence, although current data are far from conclusive. Ongoing placebo-controlled randomized trials involving potentially beneficial drug classes and examining diabetes incidence as a primary end point should provide more definitive evidence.

Antihypertensive Agents↗
PubMed2004

Antihypertensive therapy and incidence of type 2 diabetes in an elderly cohort.

OBJECTIVE: The aim of this study was to determine whether the incidence of type 2 diabetes differed among elderly users of four major antihypertensive drug classes. RESEARCH DESIGN AND METHODS: This was a retrospective, observational cohort study of previously untreated elderly patients (aged > or = 66 years) identified as new users of an antihypertensive drug class between April 1995 and March 2000. Using a Cox proportional hazards model, the primary analysis compared diabetes incidence in users of ACE inhibitors, beta-blockers, and calcium channel blockers (CCBs), with thiazide diuretics allowed as second-line therapy. In the secondary analysis, thiazide diuretics were added as a fourth study group. RESULTS: In the multivariable-adjusted primary analysis (n = 76,176), neither ACE inhibitor use (hazard ratio 0.96 [95% CI 0.84-1.1]) nor beta-blocker use (0.86 [0.74-1.0]) was associated with a statistically significant difference in type 2 diabetes incidence compared with the CCB control group. In the secondary analysis (n = 100,653), compared with CCB users, type 2 diabetes incidence was not significantly different between users of ACE inhibitors (0.97 [0.83-1.1]), beta-blockers (0.84 [0.7-1.0]), or thiazide diuretics (1.0 [0.89-1.2]). CONCLUSIONS: Type 2 diabetes incidence did not significantly differ among users of the major antihypertensive drug classes in this elderly, population-based administrative cohort. These results do not support the theory that different antihypertensive drug classes are relatively more or less likely to cause diabetes.

Age Distribution↗
PubMed2004

Population rates of hospitalization for atrial fibrillation/flutter in Canada.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained cardiac dysrhythmia and constitutes a major public health problem. AF significantly increases the risk of stroke, and anticoagulation has been shown to reduce this risk. However, Canadian data on the prevalence of AF and the use of warfarin in these patients are lacking. METHODS: International Classification of Diseases, ninth revision, codes for admissions to acute care hospitals in Canada were used to estimate the prevalence of hospitalization for AF between 1997/1998 and 1999/2000, and subsequent readmissions for stroke in all 10 provinces and overall in Canada. Warfarin use was obtained by linkage with drug benefit plans in Alberta, British Columbia, Nova Scotia and Ontario, for patients 65 years and older. RESULTS: The overall rate of hospitalization with AF between April 1, 1997, and March 31, 2000, was 582.7 per 100,000 population. The age- and sex-standardized rate rose from 513.4 to 555.3 during the three-year period of observation. The mean age was 74.4 years and 51.8% of patients were male. Of those discharged alive, 2.7% were readmitted for stroke within one year. Overall, less than one-half of the patients with AF filled a prescription for warfarin within 90 days of discharge, with only a small increase in warfarin use over the study time period. CONCLUSIONS: The rate of hospitalization with AF is increasing in Canada and is more frequent in men than in women across all age groups. Consistent with reports from other countries, warfarin use was lower than one might expect given its efficacy, with only a small increase in use over time.

Adult↗
PubMed2003

Anticoagulant-related bleeding in older persons with atrial fibrillation: physicians' fears often unfounded.

BACKGROUND: Many studies have documented the underuse of anticoagulant (ie, warfarin sodium) therapy as stroke prophylaxis in older persons with atrial fibrillation. Failure to prescribe anticoagulant agents to these patients is often due to physicians' perceiving the risk of major bleeding as unacceptably high because of the presence of such clinical risk factors as hypertension, falls, a history of gastrointestinal tract bleeding, and lack of assurance about compliance. OBJECTIVES: To critically appraise whether the presence of additional clinical factors that increase the risk of bleeding affects the chance of anticoagulant-related hemorrhage, and to develop an approach to the use of anticoagulant agents in older patients with atrial fibrillation who have any of these factors. METHODS: Systematic MEDLINE literature search from January 1966 to March 2002. RESULTS: Many of the factors that are purported to be barriers to anticoagulant therapy in older persons with atrial fibrillation probably should not influence the choice of stroke prophylaxis in these patients. These include previous episodes of upper gastrointestinal tract bleeding, predisposition to falling, and old age in itself. For some other factors, such as alcoholism, participation in activities that predispose to trauma, the presence of a bleeding diathesis or thrombocytopenia, and noncompliance with monitoring, there is little or conflicting evidence about their effect on anticoagulant-related bleeding. However, they should be considered in the clinical decision-making process. CONCLUSIONS: For many older patients with atrial fibrillation, physicians' fears of the risk of bleeding in association with anticoagulant therapy are often exaggerated and unfounded. Therefore, the salient issue in selecting older patients with atrial fibrillation for anticoagulation is accurately estimating their stroke risk, with bleeding risk during anticoagulation being a lesser issue, relevant to only a few patients.

Aged↗
PubMed2003

A clinical prediction rule to identify patients with atrial fibrillation and a low risk for stroke while taking aspirin.

BACKGROUND: We sought to derive and internally validate a simple and easily applied clinical prediction rule to identify patients with nonvalvular atrial fibrillation (AF) whose stroke risk while taking aspirin is, irrespective of age, low enough that oral anticoagulation therapy is unnecessary. METHODS: We included 2501 patients with AF treated with aspirin during participation in 6 clinical trials. Patients were randomly divided into derivation and validation sets. Recursive partitioning was used to identify patients in the derivation set whose risk for stroke (ischemic or hemorrhagic) or transient ischemic attack was comparable to that observed in an age- and sex-matched cohort from the Framingham Heart Study. The derived prediction rules were tested on the validation set. RESULTS: Overall, 166 patients (6.6%) had an event during 4688.6 person-years (PYs) of observation for an incident rate of 3.5 events per 100 PYs. Patients in the derivation set classified as low risk (no previous stroke or transient ischemic attack, no treated hypertension or systolic blood pressure equal to or exceeding 140 mm Hg, no symptomatic coronary artery disease, and no diabetes) experienced 1.0 events per 100 PYs, compared with an age- and sex-matched rate of 1.2 events per 100 PYs. In the validation set, low-risk patients experienced 1.1 events per 100 PYs (expected rate of 1.2 events per 100 PYs). Low-risk patients made up 24% of the cohort and 16% of patients older than 75 years. Low-risk patients who were randomized to therapeutic oral anticoagulation therapy experienced 1.5 events per 100 PYs. CONCLUSION: Irrespective of age, patients with AF and none of these 4 clinical features and who take aspirin have stroke rates comparable to those of age-matched community cohorts and would not benefit substantially from anticoagulation.

Aspirin↗
PubMed2003

Drug-drug interactions among elderly patients hospitalized for drug toxicity.

CONTEXT: Drug-drug interactions are a preventable cause of morbidity and mortality, yet their consequences in the community are not well characterized. OBJECTIVE: To determine whether elderly patients admitted to hospital with specific drug toxicities were likely to have been prescribed an interacting drug in the week prior to admission. DESIGN: Three population-based, nested case-control studies. SETTING: Ontario, Canada, from January 1, 1994, to December 31, 2000. PATIENTS: All Ontario residents aged 66 years or older treated with glyburide, digoxin, or an angiotensin-converting enzyme (ACE) inhibitor. Case patients were those admitted to hospital for drug-related toxicity. Prescription records of cases were compared with those of controls (matched on age, sex, use of the same medication, and presence or absence of renal disease) for receipt of interacting medications (co-trimoxazole with glyburide, clarithromycin with digoxin, and potassium-sparing diuretics with ACE inhibitors). MAIN OUTCOME MEASURE: Odds ratio for association between hospital admission for drug toxicity (hypoglycemia, digoxin toxicity, or hyperkalemia, respectively) and use of an interacting medication in the preceding week, adjusted for diagnoses, receipt of other medications, the number of prescription drugs, and the number of hospital admissions in the year preceding the index date. RESULTS: During the 7-year study period, 909 elderly patients receiving glyburide were admitted with a diagnosis of hypoglycemia. In the primary analysis, those patients admitted for hypoglycemia were more than 6 times as likely to have been treated with co-trimoxazole in the previous week (adjusted odds ratio, 6.6; 95% confidence interval, 4.5-9.7). Patients admitted with digoxin toxicity (n = 1051) were about 12 times more likely to have been treated with clarithromycin (adjusted odds ratio, 11.7; 95% confidence interval, 7.5-18.2) in the previous week, and patients treated with ACE inhibitors admitted with a diagnosis of hyperkalemia (n = 523) were about 20 times more likely to have been treated with a potassium-sparing diuretic (adjusted odds ratio, 20.3; 95% confidence interval, 13.4-30.7) in the previous week. No increased risk of drug toxicity was found for drugs with similar indications but no known interactions (amoxicillin, cefuroxime, and indapamide, respectively). CONCLUSIONS: Many hospital admissions of elderly patients for drug toxicity occur after administration of a drug known to cause drug-drug interactions. Many of these interactions could have been avoided.

Aged↗
PubMed2003

Effect of selective cyclooxygenase 2 inhibitors and naproxen on short-term risk of acute myocardial infarction in the elderly.

BACKGROUND: Recent debate has emerged regarding the cardiovascular safety of selective cyclooxygenase 2 inhibitors and the possible cardioprotective effect of naproxen sodium. We compared the rates of acute myocardial infarction (AMI) among elderly patients dispensed selective cyclooxygenase 2 inhibitors, naproxen, and nonselective nonnaproxen nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: We conducted a population-based retrospective cohort study using administrative health care data from Ontario, Canada, from April 1, 1998, to March 31, 2001. We identified NSAID-naive cohorts of subjects aged 66 years and older in whom treatment was initiated with celecoxib (n = 15 271), rofecoxib (n = 12 156), naproxen (n = 5669), and nonnaproxen nonselective NSAIDs (n = 33 868), along with a randomly selected control cohort not exposed to NSAIDs (n = 100 000). Multivariate Cox proportional hazards models were used to compare AMI rates between study drug groups while controlling for potential confounders. RESULTS: Relative to control subjects, the multivariate model showed no significant differences in AMI risk for new users of celecoxib (adjusted rate ratio [aRR], 0.9; 95% confidence interval [CI], 0.7-1.2), rofecoxib (aRR, 1.0; 95% CI, 0.8-1.4), naproxen (aRR, 1.0; 95% CI, 0.6-1.7), or nonnaproxen nonselective NSAIDs (aRR, 1.2; 95% CI, 0.9-1.4). CONCLUSIONS: The findings of this observational study suggest no increase in the short-term risk of AMI among users of selective cyclooxygenase 2 inhibitors as commonly used in clinical practice. Furthermore, the findings do not support a short-term reduced risk of AMI with naproxen.

Aged↗
PubMed2003

A qualitative study of physicians' perceptions of three decision aids.

The study objective was to investigate physicians' perceptions of three patient decision aids (DA). Semi-structured telephone interviews were conducted with 20 family physicians and 12 gynecologists about a DA for women considering long-term hormone replacement therapy; with 16 respirologists about a DA for the use of intubation and mechanical ventilation for patients with severe chronic obstructive pulmonary disease; and with 19 physicians (geriatricians, gastroenterologists, internists) about a DA for long-term placement of feeding tubes in the elderly. Participants were identified by a snowball sampling technique. The interviews were analyzed using standard qualitative methods. Most participants (81%) indicated some willingness to use the DAs. The characteristics of the DA viewed positively included it being: balanced, well organized, a useful tool, evidence-based, improves decision making process and multimedia. Some of the negative characteristics were stated as: too complex, the cost, the availability, only appropriate for certain groups of patients, and time consuming. The DAs were acceptable to most participants. Perceived positive and negative factors were similar for all DAs. Uptake of decision aids may be facilitated if physicians have an opportunity to examine and try them, and if they can have unfettered access to them for distribution purposes.

Attitude of Health Personnel↗