Abstract | OBJECTIVES: DESIGN: Population based, matched pair before and after analysis. SETTING: Database study in Ontario, Canada. PARTICIPANTS: MAIN OUTCOME MEASURES: Odds of receiving warfarin by matched pairs of a given physician's patients (one treated after and one treated before the event) were compared, with adjustment for stroke and bleeding risk factors that might also influence warfarin use. The odds of prescriptions for angiotensin converting enzyme ( ACE) inhibitor before and after the event was assessed as a neutral control. RESULTS: For the 530 physicians who had a patient with an adverse bleeding event (exposure) and who treated other patients with atrial fibrillation during the 90 days before and the 90 days after the exposure, the odds of prescribing warfarin was 21% lower for patients after the exposure (adjusted odds ratio 0.79, 95% confidence interval 0.62 to 1.00). Greater reductions in warfarin prescribing were found in analyses with patients for whom more time had elapsed between the physician's exposure and the patient's treatment. There were no significant changes in warfarin prescribing after a physician had a patient who had a stroke while not on warfarin or in the prescribing of ACE inhibitors by physicians who had patients with either bleeding events or strokes. CONCLUSIONS: A physician's experience with bleeding events associated with warfarin can influence prescribing warfarin. Adverse events that are possibly associated with underuse of warfarin may not affect subsequent prescribing.
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Authors | Niteesh K Choudhry, Geoffrey M Anderson, Andreas Laupacis, Dennis Ross-Degnan, Sharon-Lise T Normand, Stephen B Soumerai |
Journal | BMJ (Clinical research ed.)
(BMJ)
Vol. 332
Issue 7534
Pg. 141-5
(Jan 21 2006)
ISSN: 1756-1833 [Electronic] England |
PMID | 16403771
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
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Topics |
- Adult
- Aged
- Anticoagulants
(adverse effects, therapeutic use)
- Atrial Fibrillation
(drug therapy)
- Attitude to Health
- Clinical Competence
(standards)
- Epidemiologic Methods
- Female
- Hemorrhage
(psychology)
- Humans
- Male
- Medical Staff, Hospital
(psychology, standards)
- Middle Aged
- Physician-Patient Relations
- Practice Patterns, Physicians'
- Stroke
(psychology)
- Thromboembolism
(psychology)
- Warfarin
(adverse effects, therapeutic use)
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