Canadian Journal on Aging / La Revue canadienne du vieillissement

Articles

Physicians' Efficacy Requirements for Prescribing Medications to Persons with Alzheimer's Disease*

Mark Oremusa1a2 c1, Christina Wolfsona1a2a3, Howard Bergmana1a4 and Alain C Vandala1a5

a1 Centre for Clinical Epidemiology and Community Studies, S.M.B.D. Jewish General Hospital, Montreal

a2 Department of Epidemiology and Biostatistics, McGill University

a3 Department of Medicine, McGill University

a4 Division of Geriatric Medicine, S.M.B.D. Jewish General Hospital, Montreal, and McGill University

a5 Department of Mathematics and Statistics, McGill University

ABSTRACT

Physicians (N = 803) were contacted via postal survey and given two sets of efficacy measures for drug treatments in Alzheimer's disease: (a) the time that patients spend in a mild or moderate state of disease; (b) levels of modification to disease progression in the areas of cognition, behaviour, and mood, and ability to perform basic activities of daily living. Physicians reported that they would prescribe a hypothetical, new Alzheimer's disease medication if it would allow patients to remain in their current disease state for 15 (mild) or 11 (moderate) additional months. Most physicians required a permanent halt to, or some reversal of, disease progression as a prerequisite for prescribing; a few required substantial reversal. More stringent efficacy requirements were negatively associated with physicians' current prescribing of cholinesterase inhibitors to persons with Alzheimer's disease, although the effects were either small (odds ratio = 0.99) or not statistically significant at the 5 per cent level. The results suggest that physicians with stringent efficacy requirements for clinically relevant efficacy measures are less likely to prescribe cholinesterase inhibitors.

RÉSUMÉ

Des médecins (N = 803) ont été interrogés par sondage postal sur deux ensembles de critères de jugement de l'efficacité des traitements médicamenteux de la maladie d'Alzheimer: (a) la durée de la maladie d'intensité légère ou modérée et (b) les degrés de modification de la progression de la maladie sur les plans de la cognition, du comportement et de l'humeur, et la capacité d'accomplir les activités courantes élémentaires. Les médecins ont répondu qu'ils prescriraient un nouveau médicament hypothétique s'il permettait de maintenir l'état actuel de la maladie pendant 15 mois (maladie légère) ou 11 mois (maladie modérée). La plupart des médecins s'attendent à ce que le médicament freine de façon permanente la progression de la maladie ou que celle-ci recule avant de prescrire le médicament ; quelques-uns ne le prescriront que s'il fait reculer la maladie de façon remarquable. Des critères d'efficacité stricts influencent négativement le comportement de prescription actuel des médecins en ce qui concerne les inhibiteurs de la cholinestérase dans le maladie d'Alzheimer, quoique l'effet soit faible (ratio d'incidence approché = 0,99), ou non statistiquement significatif au niveau de cinq p. cent. Les résultats révèlent que les médecins qui appliquent des critères de jugement stricts aux paramètres d'efficacité d'importance clinique sont moins enclins à prescrire des inhibiteurs de la cholinestérase.

(Received October 31 2005)

(Accepted December 16 2006)

Correspondence:

c1 Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à: Mark Oremus, PhD, McMaster Evidence-based Practice Centre, Department of Clinical Epidemiology and Biostatistics, McMaster University DTC, Room 326, 50 Main Street East, Hamilton, ON L8N 1E9. (oremusm@mcmaster.ca)

Mark Oremus was funded by a doctoral training award from the Institute of Aging of the Canadian Institutes of Health Research and by a graduate student research grant from the Scottish Rite Charitable Foundation of Canada.

Howard Bergman has received funding from Janssen-Ortho, Novartis, and Pfizer to conduct clinical trials of cholinesterase inhibitors.

Footnotes

* The authors wish to thank the physicians who kindly took part in the survey.

A portion of this manuscript was accepted as a poster presentation at the Canadian Association for Population Therapeutics Annual Conference, 16–19 April 2005, Vancouver, BC.