Objective - To study factors influencing GPs' decisions to prescribe lipid-
lowering drugs and how their judgements agree with the Swedish guidelines o
n hyperlipidaemia.
Design-Postal questionnaire.
Setting - Primary health care. Authentic written case descriptions of patie
nts, all with a cholesterol value of at least 5.5 mmol/l and with variation
s in seven other variables (cues) in a Clinical Judgement Analysis (CJA) de
sign.
Subjects - Sixty randomly selected primary health care doctors in the south
-eastern Stockholm area.
Results - Thirty-eight doctors answered the questionnaire. Coronary heart d
isease had the highest influence on judgements, followed by cholesterol. Th
e majority of doctors used two or three of the eight cues. Doctors differed
markedly in their strategies. One in four did not use coronary heart disea
se in their judgements, even though all patients with this risk factor pres
ent (12/40) should receive pharmacological treatment, according to the guid
elines. Doctors who adhered to the guidelines in this respect were younger
than those who did not. The GPs' insights into their own strategies were go
od.
Conclusions - The results indicate that doctors use very different judgemen
t strategies for drug prescription concerning patients with hypercholestero
laemia. A fairly large subgroup of the doctors did not include coronary hea
rt disease in their judgements, in contrast to the present guidelines.