HOW DO GPS USE CLINICAL INFORMATION IN THEIR JUDGMENTS OF HEART-FAILURE - A CLINICAL JUDGMENT ANALYSIS STUDY

Objective - To study general practitioners' (GP) clinical diagnoses of heart failure. Design - A Clinical Judgement Analysis study. Setting - Primary health care. Subjects - Twenty-seven GPs from nine health ce ntres in Stockholm County. Intervention - Forty-five case vignettes, b ased on actual patients from two health centres in Stockholm, were pre sented to each GP. For each case vignette, the GPs judged the probabil ity of heart failure. Main outcome measures - The GPs' assessments of the probability of heart failure in the case vignettes. The GPs' utili zation of clinical information in their judgement strategies, as measu red by the regression coefficients in a multiple regression equation, with the probability assessments as dependent and the clinical criteri a as independent variables. Results - The variation between the GPs' a ssessments of the probability of heart failure was considerable. The j udgemental strategies differed between the doctors, the most important variables for most of them being lung and heart X-rays and a history of myocardial infarction. Conclusions - With new treatment recommendat ions, it has become increasingly important to identify patients with h eart failure. This study demonstrates large differences in GPs' diagno ses of heart failure. An important source of this variation is the dif ferences in how they make use of clinical information.