KNOWLEDGE AND PRACTICES OF GENERALIST AND SPECIALIST PHYSICIANS REGARDING DRUG-THERAPY FOR ACUTE MYOCARDIAL-INFARCTION

Background. The respective roles of generalist and specialist physicia ns in the care of patients are currently a matter of debate. Informati on is limited about the knowledge and practices of generalist and spec ialist physicians regarding conditions that both groups treat, such as myocardial infarction. Methods. We therefore surveyed 1211 cardiologi sts, internists, and family practitioners in the states of New York an d Texas about four treatments demonstrated by randomized clinical tria ls to be associated with improved survival after myocardial infarction (thrombolytic therapy, immediate and long-term use of aspirin, and lo ng-term use of beta-blockers) and two treatments for which such eviden ce is lacking (diltiazem for patients with pulmonary congestion and pr ophylactic lidocaine). We asked physicians about the effect of each tr eatment on survival and the likelihood that they would prescribe each class of drugs. Results. For the four beneficial treatments, the cardi ologists believed more strongly than the internists and family physici ans that survival was improved by the treatment, and they were more li kely to prescribe these drugs (P<0.001). For example, 94.1 percent of cardiologists said they were very likely to prescribe thrombolytic age nts to treat an acute myocardial infarction, as compared with 82.0 per cent of internists and 77.3 percent of family practitioners. Conversel y, for the two treatments for which trials showed no evidence of a sur vival benefit, cardiologists were less likely than internists and fami ly practitioners to think there was such a benefit and less likely to prescribe the drugs (P<0.001). For example, 4.7 percent of cardiologis ts reported that they were very likely to use prophylactic lidocaine, as compared with 13.1 percent of internists, and 16.5 percent of famil y practitioners. When we used logistic regression to adjust for potent ial confounders, all the differences between the cardiologists and the internists and family practitioners remained significant (P<0.02). Co nclusions. Internists and family practitioners are less aware of or le ss certain about key advances in the treatment of myocardial infarctio n than are cardiologists. This finding underscores the need to improve the dissemination of information from clinical trials to generalist p hysicians, particularly if they are to have an enlarged role in the ev olving health care system.