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Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany

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Knesebeck , Olaf von dem, Bönte, Markus, Siegrist, Johannes, Marceau, Lisa, Link, Carol, Arber, Sara, Adams, Ann and McKinlay, John. (2008) Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany. BMC Health Services Research, Vol.8 (No.198). ISSN 1472-6963

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Official URL: http://dx.doi.org/10.1186/1472-6963-8-198

Abstract

Background The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany. Methods Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions. Results Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice. Conclusion Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Mental Health and Wellbeing Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Coronary heart disease -- United States, Coronary heart disease -- United Kingdom, Coronary heart disease -- Germany
Journal or Publication Title:	BMC Health Services Research
Publisher:	BioMed Central Ltd.
ISSN:	1472-6963
Date:	29 September 2008
Volume:	Vol.8
Number:	No.198
Identification Number:	10.1186/1472-6963-8-198
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	National Institute on Aging (NIA)
Grant number:	Grant No. AG 16747
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URI:	http://wrap.warwick.ac.uk/id/eprint/241