Factors influencing GPs' decisions on the treatment of hypercholesterolaemic patients

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.